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General NPI Number Information
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NPI Number | 1154864866
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Entity Type | Organization
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Legal Business Name | LIFESTAR EMERGENCY SERVICES - 2023
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 3475 MYER LEE DR
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City | WINSTON SALEM
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State | NC
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Zip | 27101-6209
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Country | US
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Telephone | 336-722-5433
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Fax | 888-758-5694
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | LEWISVILLE
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State | NC
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Zip | 27023-0309
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Country | US
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Telephone | 336-722-5433
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Fax | 363-232-1532
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL LEE HOOTS
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Credential |
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Telephone | 336-722-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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