Lifeline Pediatrics Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

19922 Issued in WV

Legal business name

LIFELINE PEDIATRICS INC

Practice address

100 Paducah Dr
New Martinsville, WV 26155-2710

Phone

(304) 455-3611

NPI assigned

Mar 8, 2007

Organization subpart

No

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

Authorized official

Name

Ibanga M Ekanem, M.D.

Title

Owner

Phone

(304) 455-3611

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1598896193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PADUCAH DRIVE",
            "city": "NEW MARTINSVILLE",
            "state": "WV",
            "postal_code": "26155",
            "telephone_number": "304-455-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PADUCAH DR",
            "city": "NEW MARTINSVILLE",
            "state": "WV",
            "postal_code": "261552710",
            "telephone_number": "304-455-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELINE PEDIATRICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2011-08-19",
        "status": "A",
        "authorized_official_last_name": "EKANEM",
        "authorized_official_first_name": "IBANGA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-455-3611",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WV",
            "license": "19922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006383",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Norma Jean Leehugh
• Kristin Lemmings
• Audra Lemon, FNP
• Jessica Maria Lewis, FNP-C
• Life Guard Inc.
• Andrea M. Lockhart, DDS
• Samantha Long
• Hannah Jo Longwell
• Raven N Longwell
• Vickey J Longwell

• Specialist in New Martinsville, WV
• Providers in New Martinsville, WV by specialty
• Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; 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.