Healthcare Provider Details

I. General information

NPI: 1427038355
Provider Name (Legal Business Name): LIFESTAT AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SALT ST STE 1
SALTSBURG PA
15681-1122
US

IV. Provider business mailing address

301 SALT ST STE 1
SALTSBURG PA
15681-1122
US

V. Phone/Fax

Practice location:
  • Phone: 724-639-3043
  • Fax: 724-639-3343
Mailing address:
  • Phone: 724-639-3043
  • Fax: 724-639-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03374
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN C KRAVETSKY
Title or Position: PRESIDENT
Credential: CRITICAL CARE EMT P
Phone: 724-639-3868