| Organization Name: | LIFEGUARD AMBULANCE SERVICE LLC |
| NPI Number: | 1760831630 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIC THOMAS (SVP OF REVENUE MANAGEMENT) |
| Mailing Address: | 630 Purvis Oloh Rd Purvis |
| State: | MS US |
| Postal Code: | 394754284 |
| Phone Number: | 8663331665 |
| Fax Number: | 2053802074 |
| NPI Enumeration Date: | 06/10/2016 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |