Provider Demographics
NPI:1699907568
Name:LIFESTAR EMERGENCY SERVICES LLC
Entity type:Organization
Organization Name:LIFESTAR EMERGENCY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-722-5433
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0429
Mailing Address - Country:US
Mailing Address - Phone:363-722-5433
Mailing Address - Fax:336-722-0685
Practice Address - Street 1:3475 MYER LEE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-6209
Practice Address - Country:US
Practice Address - Phone:336-722-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0341525341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance