MEDICARE: NORTHSTAR LIFE SAFETY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi
2	343800000X	Secured Medical Transport (VAN)

General Provider Information

NPI Number	:	1881422830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR LIFE SAFETY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-0100
Country	:	US
Telephone Number	:	320-309-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	32472 91ST AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8651
Country	:	US
Telephone Number	:	320-309-0654
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM DAVID FETTIG
Credential	:	NRP
Telephone Number	:	320-309-0654

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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Directions to “NORTHSTAR LIFE SAFETY SERVICES ” Practice Location

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