Life Star Healthcare LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMT0000030252 Issued in TN

Legal business name

LIFE STAR HEALTHCARE LLC

Practice address

111 Glendale St
Jackson, TN 38301-5101

Phone

(615) 974-1632

NPI assigned

Nov 3, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Michael Douglas Henderson, EMT-PARAMEDIC

Title

Owner

Phone

(615) 974-1632

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225670400000",
    "number": "1760635700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 GLENDALE ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015101",
            "telephone_number": "615-974-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GLENDALE ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015101",
            "telephone_number": "615-974-1632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE STAR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-03",
        "last_updated": "2008-11-03",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-974-1632",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EMT-PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TN",
            "license": "EMT0000030252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Jackson, TN
• Providers in Jackson, TN by specialty
• Land Ambulance in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; 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.