Healthcare Provider Details

I. General information

NPI: 1033307871
Provider Name (Legal Business Name): UT LIFESTAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 FIRST QUALITY DRIVE
ANDERSONVILLE TN
37705-4132
US

IV. Provider business mailing address

PO BOX 708
WEST PLAINS MO
65775-0708
US

V. Phone/Fax

Practice location:
  • Phone: 865-256-6284
  • Fax:
Mailing address:
  • Phone: 417-257-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberEMS0000010038
License Number StateTN

VIII. Authorized Official

Name: DAVID HINTON
Title or Position: VP OF FINANCE
Credential:
Phone: 417-256-0010