Provider Demographics
NPI:1033307871
Name:UT LIFESTAR, LLC
Entity Type:Organization
Organization Name:UT LIFESTAR, LLC
Other - Org Name:UT LIFESTAR 4
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-0010
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-0708
Mailing Address - Country:US
Mailing Address - Phone:417-257-2104
Mailing Address - Fax:
Practice Address - Street 1:131 FIRST QUALITY DRIVE
Practice Address - Street 2:
Practice Address - City:ANDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37705-4132
Practice Address - Country:US
Practice Address - Phone:865-256-6284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000100383416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport