MEDICARE: LIFESTAR RESPONSE OF ALABAMA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	003074	AL
2	3416L0300X	Land Ambulance	1039	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285621797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTAR RESPONSE OF ALABAMA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 530481
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-0481
Country	:	US
Telephone Number	:	888-876-2100
Fax Number	:	888-790-0688

Provider Business Practice Location Address
First Line	:	1150 PANAMA ST. SOUTH
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-2704
Country	:	US
Telephone Number	:	800-449-4911
Fax Number	:	334-262-2538

Authorized Official
Title or Position	:	REGIONAL CEO
Name	:	MR. CHARLES MAYMON
Credential	:
Telephone Number	:	954-868-6668

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/02/2018

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