Basic Information
| Provider Information | |||||||||
| NPI: | 1265107478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFELINE HOSPITALIST ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4022 E PRESIDIO ST | ||||||||
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| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852151113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809851093 | ||||||||
| FaxNumber: | 4802967665 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 W BROWN RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852013404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809851093 | ||||||||
| FaxNumber: | 4802967665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2021 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHRIMALI | ||||||||
| AuthorizedOfficialFirstName: | MUKESH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4809851093 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.