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General NPI Number Information
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NPI Number | 1366424707
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Entity Type | Organization
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Legal Business Name | LIFESTAR EMERGENCY MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 279 S 17TH AVE STOP 8
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City | WEST BEND
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State | WI
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Zip | 53095-3001
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Country | US
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Telephone | 262-335-9950
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Fax | 262-335-9720
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Provider Business Mailing Address
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Address Line | PO BOX 113
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City | WEST BEND
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State | WI
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Zip | 53095-0113
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Country | US
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Telephone | 262-335-9950
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Fax | 262-335-9720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL L KRUEGER
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Credential | EMTP
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Telephone | 262-335-9950
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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 | 6001359
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License Number State | WI
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