MEDICARE: LIFESTAT AMBULANCE SERVICE 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	03374	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13522	OTHER		MED PLUS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A28600	OTHER		HEALTH AMERICA
4	1001414	OTHER		GATEWAY
5	205534	OTHER		HIGHMARKS
6	205534	OTHER		HGSADMIN
7	8190160	OTHER		INDEPENDENT HEALTH
8	1811395600001	OTHER		MEDICAL ASSIST DPA
9	205534	OTHER		KEYSTONE HEALTH PLAN
10	205534	OTHER		SELECT BLUE
11	P219938	OTHER		CHAMPUS TRICARE
12	0944090	OTHER	OH	OHIO MEDICAL ASSIST
13	205534	OTHER		SECURITY BLUE
14	6472	OTHER		HEALTH ASSURANCE
15	1412565	OTHER		UMWA
16	69619	OTHER		THREE RIVERS

General Provider Information

NPI Number	:	1427038355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTAT AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	301 SALT ST
Second Line	:	STE 1
City	:	SALTSBURG
State	:	PA
Zip	:	15681-1122
Country	:	US
Telephone Number	:	724-639-3043
Fax Number	:	724-639-3343

Provider Business Practice Location Address
First Line	:	301 SALT ST
Second Line	:	STE 1
City	:	SALTSBURG
State	:	PA
Zip	:	15681-1122
Country	:	US
Telephone Number	:	724-639-3043
Fax Number	:	724-639-3343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN C KRAVETSKY
Credential	:	CRITICAL CARE EMT P
Telephone Number	:	724-639-3868

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/22/2020

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Directions to “LIFESTAT AMBULANCE SERVICE INC ” Practice Location

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