Healthcare Provider Details

I. General information

NPI: 1285621797
Provider Name (Legal Business Name): LIFESTAR RESPONSE OF ALABAMA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 PANAMA ST. SOUTH
MONTGOMERY AL
36107-2704
US

IV. Provider business mailing address

PO BOX 530481
ATLANTA GA
30353-0481
US

V. Phone/Fax

Practice location:
  • Phone: 800-449-4911
  • Fax: 334-262-2538
Mailing address:
  • Phone: 888-876-2100
  • Fax: 888-790-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number003074
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1039
License Number StateAL

VIII. Authorized Official

Name: MR. CHARLES MAYMON
Title or Position: REGIONAL CEO
Credential:
Phone: 954-868-6668