Provider Demographics
NPI:1427038355
Name:LIFESTAT AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LIFESTAT AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRAVETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:CRITICAL CARE EMT P
Authorized Official - Phone:724-639-3868
Mailing Address - Street 1:301 SALT ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SALTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15681-1122
Mailing Address - Country:US
Mailing Address - Phone:724-639-3043
Mailing Address - Fax:724-639-3343
Practice Address - Street 1:301 SALT ST
Practice Address - Street 2:STE 1
Practice Address - City:SALTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15681-1122
Practice Address - Country:US
Practice Address - Phone:724-639-3043
Practice Address - Fax:724-639-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
13522OtherMED PLUS
PA1811395600001Medicaid
A28600OtherHEALTH AMERICA
1001414OtherGATEWAY
205534OtherHIGHMARKS
205534OtherHGSADMIN
8190160OtherINDEPENDENT HEALTH
1811395600001OtherMEDICAL ASSIST DPA
205534OtherKEYSTONE HEALTH PLAN
205534OtherSELECT BLUE
P219938OtherCHAMPUS TRICARE
OH0944090OtherOHIO MEDICAL ASSIST
205534OtherSECURITY BLUE
6472OtherHEALTH ASSURANCE
1412565OtherUMWA
69619OtherTHREE RIVERS
205534OtherSELECT BLUE