Provider Demographics
NPI:1093802035
Name:LIFESTAR AMBULANCE INC
Entity Type:Organization
Organization Name:LIFESTAR AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-656-4911
Mailing Address - Street 1:2427 SUSQUEHANNA ROAD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001
Mailing Address - Country:US
Mailing Address - Phone:800-656-4911
Mailing Address - Fax:800-803-5345
Practice Address - Street 1:2427 SUSQUEHANNA ROAD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001
Practice Address - Country:US
Practice Address - Phone:800-656-4911
Practice Address - Fax:800-803-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03235341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA34320OtherHEALTH PARTNERS
PA1008148260001Medicaid
PA0002060000OtherINDEPENCE BLUE CROSS
PA30015383OtherKEYSTONE MERCY
PA34320OtherHEALTH PARTNERS