Provider Demographics
NPI:1710280649
Name:LIFE STAR MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:LIFE STAR MEDICAL TRANSPORT, LLC
Other - Org Name:LIFE STAR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:IOFIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-776-3224
Mailing Address - Street 1:7 ESSEX LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2038
Mailing Address - Country:US
Mailing Address - Phone:215-776-3224
Mailing Address - Fax:
Practice Address - Street 1:111 BUCK RD
Practice Address - Street 2:200-6
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1544
Practice Address - Country:US
Practice Address - Phone:215-776-3224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport