Organization
LIFESTAR AMBULANCE SERVICE,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER D. CAMPBELL (PRESIDENT)
(618) 532-2474
Entity
Organization
Contact information
Practice address
940 N ELM ST, CENTRALIA, IL 62801-2326
(618) 532-2474
(618) 532-7795
Mailing address
940 N ELM ST, PO BOX 1838, CENTRALIA, IL 62801-2326
(618) 532-2474
(618) 532-7795
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
5225
IL
3416L0300X
Land Ambulance
—
—
Other
Enumeration date
05/19/2006
Last updated
07/17/2023
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