Organization
LIFESTAR AMBULANCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELINE TARR FOWLER RN, CRTT (PRESIDENT)
(410) 546-0809
Entity
Organization
Contact information
Practice address
1024 S TOWER DR, SALISBURY, MD 21804-6474
(410) 546-0809
(410) 860-5260
Mailing address
1024 S TOWER DR, SALISBURY, MD 21804-6474
(410) 546-0809
(410) 860-5260
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
063
MD
343900000X
Non-emergency Medical Transport (VAN)
2204
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141515
—
DE
Enumeration date
08/13/2006
Last updated
10/16/2007
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