Provider Demographics
NPI:1316375546
Name:LIFE SUPPORT TEAM INC
Entity Type:Organization
Organization Name:LIFE SUPPORT TEAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:419-462-1346
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44862-0111
Mailing Address - Country:US
Mailing Address - Phone:419-462-1346
Mailing Address - Fax:
Practice Address - Street 1:363 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2064
Practice Address - Country:US
Practice Address - Phone:419-462-1346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-25
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
H304830Medicare UPIN
H304830Medicare PIN
H304830Medicare Oscar/Certification