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General NPI Number Information
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NPI Number | 1912910092
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Entity Type | Organization
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Legal Business Name | LIFESTAR AMBULANCE, INC.
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 1024 S TOWER DR
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City | SALISBURY
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State | MD
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Zip | 21804-6474
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Country | US
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Telephone | 410-546-0809
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Fax | 410-860-5260
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Provider Business Mailing Address
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Address Line | 1024 S TOWER DR
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City | SALISBURY
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State | MD
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Zip | 21804-6474
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Country | US
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Telephone | 410-546-0809
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Fax | 410-860-5260
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JACQUELINE TARR FOWLER
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Credential | RN, CRTT
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Telephone | 410-546-0809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 2204
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 063
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License Number State | MD
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