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General NPI Number Information
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NPI Number | 1316375546
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Entity Type | Organization
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Legal Business Name | LIFE SUPPORT TEAM INC
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 363 MARION AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-2064
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Country | US
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Telephone | 419-462-1346
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | ONTARIO
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State | OH
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Zip | 44862-0111
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Country | US
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Telephone | 419-462-1346
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS L DURBIN
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Credential | EMT-P
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Telephone | 419-462-1346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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