Lifeguard Ambulance Service LLC
Organization Active NPI Land Ambulance · Waverly, TN
NPI 1043746902 · NPPES record last updated Feb 10, 2022
Key facts
- NPI
- 1043746902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- LIFEGUARD AMBULANCE SERVICE LLC
- Practice address
- 411 W Main St
Waverly, TN 37185-1107 - Phone
- (931) 296-2355
- NPI assigned
- May 11, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- LIFEGUARD AMBULANCE SERVICE LLC
Authorized official
- Name
- Eric Thomas
- Title
- SVP of Revenue Management
- Phone
- (833) 703-2294
Other NPIs on the same Medicare enrollment 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140729000427 | TN | Part B Supplier - Ambulance Service Supplier | 0143453142 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Knoxville, TN |
National Provider Directory
- Part of
- Lifeguard Amb SVC LLC
Locations
411 W Main St
Waverly, TN 37185
Phone (205) 933-1911
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | |||
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
411 W Main St
Waverly, TN 37185-1107
Mailing address
PO Box 198408
Atlanta, GA 30384-8408
Phone (800) 913-9106
Other providers in Waverly, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.