Provider Demographics
NPI:1871720243
Name:LIFEGUARD AMBULANCE
Entity type:Organization
Organization Name:LIFEGUARD AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-852-2413
Mailing Address - Street 1:PO BOX 52087
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-7087
Mailing Address - Country:US
Mailing Address - Phone:215-852-2413
Mailing Address - Fax:
Practice Address - Street 1:10000C JEANES STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116
Practice Address - Country:US
Practice Address - Phone:215-852-2413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076388OtherMEDICARE PROVIDER ID