Provider Demographics
NPI:1366424707
Name:LIFESTAR EMERGENCY MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:LIFESTAR EMERGENCY MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:262-335-9950
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-0113
Mailing Address - Country:US
Mailing Address - Phone:262-335-9950
Mailing Address - Fax:262-335-9720
Practice Address - Street 1:279 S 17TH AVE STOP 8
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3001
Practice Address - Country:US
Practice Address - Phone:262-335-9950
Practice Address - Fax:262-335-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60013593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41353100Medicaid
WI41475100Medicaid
WI41475100Medicaid