NPIMap

Organization Active NPI

Lifeguard Ambulance Service LLC

Doing business as MedStar

  • Land Ambulance
  • Summerdale, AL
National Provider Identifier
1891240859
Registry record updated Sep 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
LIFEGUARD AMBULANCE SERVICE LLC
Doing business as
MedStar
Practice address
106 Highway 59 S
Summerdale, AL 36580-3690
Phone
(417) 257-1605
Fax
(205) 380-2074
NPI assigned
Aug 19, 2016
Organization subpart
Yes
Parent organization
LIFEGUARD AMBULANCE SERVICE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2025

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

Authorized official

Name
Timothy Joseph Dorn
Title
Chief Administrative Officer
Phone
(833) 703-2294

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

106 Highway 59 S
Summerdale, AL 36580-3690

Mailing address

PO Box 198408
Atlanta, GA 30384-8408
Phone (800) 913-9106

Other identifiers 5

IdentifierTypeStateIssuer
000930029MedicaidMS
7100572180MedicaidKY
Q030101MedicaidTN
197945MedicaidAL
020743700MedicaidFL

Other names 1

  • MedStar Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140721001284 AL Part B Supplier - Ambulance Service Supplier 0143453142 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Summerdale, AL; Warrior, AL; Killen, AL; Hartselle, AL; Gardendale, AL; Foley, AL; Florence, AL; Bay Minette, AL…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2127116Lifeguard Ambulance Service LLC - Medstar106 Highway 59 S Attn Mike Sandell, Summerdale, AL 36580Certificate of waiverMar 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lifeguard Ambulance Serv10 organizations share this tax ID, including this one
Part of
Lifeguard Ambulance Serv

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1471564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757894400000",
    "number": "1891240859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198408",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848408",
            "telephone_number": "800-913-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 HIGHWAY 59 S",
            "city": "SUMMERDALE",
            "state": "AL",
            "postal_code": "365803690",
            "telephone_number": "417-257-1605",
            "fax_number": "205-380-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEGUARD AMBULANCE SERVICE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEGUARD AMBULANCE SERVICE LLC",
        "enumeration_date": "2016-08-19",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A",
        "authorized_official_last_name": "DORN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "833-703-2294"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000930029",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100572180",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q030101",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197945",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020743700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedStar",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedStar",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerdale, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.