Life Line Surgical Services LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

33400 Issued in MO

Legal business name

LIFE LINE SURGICAL SERVICES LLC

Practice address

10004 Kennerly Rd
Suite 330-a
Saint Louis, MO 63128-2141

Phone

(314) 718-9947

Fax

(314) 718-9947

NPI assigned

Nov 23, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Della Aridge, NPNPI 1497837959

Title

Nurse/Manager

Phone

(314) 591-1125

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Della Louise Aridge, RN, MSN, NP

  • Family Nurse Practitioner
  • Saint Louis, MO
  • NPI 1497837959
  Medicare reassignment Authorized official
• Paul James Garvin, MD

  • Transplant Surgery Physician
  • Saint Louis, MO
  • NPI 1407950017
  Medicare reassignment Care Compare group
• Lisa M Grahek-Lindsey, PAC

  • Physician Assistant
  • Saint Louis, MO
  • NPI 1467418590
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1258934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1851629356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "SUITE 330-A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282141",
            "telephone_number": "314-718-9947",
            "fax_number": "314-718-9947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 KENNERLY RD",
            "address_2": "SUITE 330-A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282141",
            "telephone_number": "314-718-9947",
            "fax_number": "314-718-9947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE LINE SURGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-23",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "ARIDGE",
        "authorized_official_first_name": "DELLA",
        "authorized_official_title_or_position": "NURSE/MANAGER",
        "authorized_official_telephone_number": "314-591-1125",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MO",
            "license": "33400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CPIN",
            "identifier": "16010260",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1407950017",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life Aid Medical Supplies Inc
• Life Connections Home Solutions LLC
• Life Development Support Centers
• Life Forward Home Health Services LLC
• Life Fountain Health Care, Inc
• Life Links Home Healthcare Services, Inc
• Life Skills Foundation
• Life Skills Foundation
• Life Skills Foundation, Inc
• Life Skills Therapy Services, LLC

• Surgery Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.