Provider Demographics
NPI:1619051398
Name:LIFESTAR AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:LIFESTAR AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-563-1553
Mailing Address - Street 1:PO BOX 9324
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9324
Mailing Address - Country:US
Mailing Address - Phone:706-563-1553
Mailing Address - Fax:706-563-1553
Practice Address - Street 1:4422 MILLER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4065
Practice Address - Country:US
Practice Address - Phone:706-563-1553
Practice Address - Fax:706-563-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-06341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA59RCBGFMedicare ID - Type Unspecified