# MEDSTAR AMBULANCE INC

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

## Provider details

- **NPI number:** 1235397282
- **Authorized official:** MRS. DEBORAH D KELLEY (HUMAN RESOURCE 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 | 4837 | IL | Yes |

## Other

- **Enumeration date:** 05/27/2008
- **Last updated:** 05/27/2008