NPIMap

Organization Active NPI

Lifeguard Ambulance Service LLC

  • Land Ambulance
  • North Charleston, SC
National Provider Identifier
1982198289
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
LIFEGUARD AMBULANCE SERVICE LLC
Practice address
3111 Meeting Street Rd Unit a
North Charleston, SC 29405-7980
Phone
(843) 792-7997
NPI assigned
Jun 20, 2018
Organization subpart
Yes
Parent organization
LIFEGUARD AMBULANCE SERVICE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Timothy Joseph Dorn
Title
Chief Administrative Officer
Phone
(833) 703-2294

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

3111 Meeting Street Rd Unit a
North Charleston, SC 29405-7980

Mailing address

PO Box 198408
Atlanta, GA 30384-8408
Phone (800) 913-9106

Other identifiers 1

IdentifierTypeStateIssuer
AB0379MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171218000021 SC Part B Supplier - Ambulance Service Supplier 0143453142 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cheraw, SC; Chesterfield, SC; Hartsville, SC; Jefferson, SC; North Charleston, SC; Pageland, SC; Richburg, SC; Timmonsville, SC

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2149746Lifeguard Ambulance Service, LLC3111 Meeting Street Road - Unit a, North Charleston, SC 29405Certificate of waiverJun 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lifeguard Amb SVC LLC10 organizations share this tax ID, including this one
Part of
Lifeguard Amb SVC LLC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1524 Barnwell Hwy
Denmark, SC 29042
Phone (803) 395-3352

3111 Meeting Street Rd
Unit A
North Charleston, SC 29405
Phone (843) 792-7997

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1982198289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198408",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848408",
            "telephone_number": "800-913-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 MEETING STREET RD UNIT A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294057980",
            "telephone_number": "843-792-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEGUARD AMBULANCE SERVICE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEGUARD AMBULANCE SERVICE LLC",
        "enumeration_date": "2018-06-20",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "DORN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "833-703-2294"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AB0379",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.