# MEDSTAR AMBULANCE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013900364
- **Authorized official:** DEBORAH D KELLEY (HUMANRESOURCES MANAGER)
- **Authorized official phone:** (618) 443-5061

## Contact information

- **Practice address:** 705 BRADBURY LN, SPARTA, IL 62286-2102
- **Practice address phone:** (618) 443-5061
- **Practice address fax:** (618) 443-3897
- **Mailing address:** PO BOX 296, SPARTA, IL 62286-0296
- **Mailing address phone:** (618) 443-5061
- **Mailing address fax:** (618) 443-3897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 44837 | IL | Yes |

## Other

- **Enumeration date:** 08/23/2005
- **Last updated:** 05/08/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0007915009 | BCBS | — |
| 01 | — | 088141300 | FEDERAL BLACK LUNG | — |
| 01 | — | 133392100 | HEALTHCARE USA | — |
| 01 | — | 154099XX | PREFERRED CARE | — |