Provider Demographics
NPI:1104289149
Name:STARS MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:STARS MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OSOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-337-3626
Mailing Address - Street 1:1068 RAYMOND AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1541
Mailing Address - Country:US
Mailing Address - Phone:571-337-3626
Mailing Address - Fax:
Practice Address - Street 1:1068 RAYMOND AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1541
Practice Address - Country:US
Practice Address - Phone:571-337-3626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherNON EMERGENCY MEDICAL TRANSPORTATION
MN=========OtherNON EMERGENCY MEDICAL TRANSPORT