Provider Demographics
NPI:1093487878
Name:LIFESTAR RURAL EMS SOLUTIONS
Entity type:Organization
Organization Name:LIFESTAR RURAL EMS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:PAINE
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:208-781-1862
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:GARDEN VALLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83622-0758
Mailing Address - Country:US
Mailing Address - Phone:208-781-1862
Mailing Address - Fax:
Practice Address - Street 1:3 PUMP HOUSE RD
Practice Address - Street 2:
Practice Address - City:GARDEN VALLEY
Practice Address - State:ID
Practice Address - Zip Code:83622-5059
Practice Address - Country:US
Practice Address - Phone:208-781-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport