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General NPI Number Information
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NPI Number | 1285621797
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Entity Type | Organization
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Legal Business Name | LIFESTAR RESPONSE OF ALABAMA, INC.
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 1150 PANAMA ST. SOUTH
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City | MONTGOMERY
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State | AL
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Zip | 36107-2704
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Country | US
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Telephone | 800-449-4911
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Fax | 334-262-2538
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Provider Business Mailing Address
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Address Line | PO BOX 530481
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City | ATLANTA
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State | GA
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Zip | 30353-0481
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Country | US
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Telephone | 888-876-2100
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Fax | 888-790-0688
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Authorized Official
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Title or Position | REGIONAL CEO
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Name | MR. CHARLES MAYMON
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Credential |
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Telephone | 954-868-6668
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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 | 003074
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1039
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License Number State | AL
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