NPIMap

Organization Active NPI

Lifeline Mobile Medics

  • Ambulance
  • Bloomington, IL
National Provider Identifier
1497761886
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
Legal business name
LIFELINE MOBILE MEDICS
Practice address
112 Southgate Dr
#B
Bloomington, IL 61704-7639
Phone
(309) 828-8572
Fax
(309) 827-3060
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Keith Richard Dutton
Title
Ceo
Phone
(309) 828-8572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X IL Primary

Addresses

Primary practice location

112 Southgate Dr
#B
Bloomington, IL 61704-7639

Mailing address

112 Southgate Dr
#B
Bloomington, IL 61704-7639
Phone (309) 828-8572

National Provider Directory

National Provider Directory

Locations

112 Southgate Dr
Unit B
Bloomington, IL 61704
Phone (309) 828-8572

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497761886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 SOUTHGATE DR",
            "address_2": "#B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047639",
            "telephone_number": "309-828-8572",
            "fax_number": "309-827-3060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 SOUTHGATE DR",
            "address_2": "#B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047639",
            "telephone_number": "309-828-8572",
            "fax_number": "309-827-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE MOBILE MEDICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUTTON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-828-8572"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.