Lifestar LLC

Primary specialty

AmbulanceTaxonomy code 341600000X

License

58 Issued in AZ

Legal business name

LIFESTAR LLC

Doing business as

Canyon State Ambulance

Practice address

1014 S Westerly
Payson, AZ 85541

Phone

(928) 474-2831

Fax

(928) 474-6188

NPI assigned

Dec 28, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ralph J Vassallo Jr.

Title

Vice President of Billing Services

Phone

(602) 437-6620

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Canyon State Ambulance Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257206400000",
    "number": "1699752998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 63068",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850823068",
            "telephone_number": "602-437-1431",
            "fax_number": "602-437-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 S WESTERLY",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "85541",
            "telephone_number": "928-474-2831",
            "fax_number": "928-474-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2009-11-03",
        "status": "A",
        "authorized_official_last_name": "VASSALLO",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT OF BILLING SERVICES",
        "authorized_official_telephone_number": "602-437-6620",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "AZ",
            "license": "58",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "590015162",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0152310",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620949",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon State Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gilles Lachance, MD
• Lee a Woods LCSW PC
• Judith Kay Lee, LCSW, LIMHP
• Libbie Ann Lee, DPT
• Betty Ann Liebzeit, RN
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• Ambulance in Payson, AZ
• Providers in Payson, AZ by specialty
• Ambulance in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.