Provider Demographics
NPI:1194255018
Name:WESTERN STAR HOSPITAL AUTHORITY INC
Entity type:Organization
Organization Name:WESTERN STAR HOSPITAL AUTHORITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-937-6660
Mailing Address - Street 1:1145 HIGHTOWER TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2981
Mailing Address - Country:US
Mailing Address - Phone:404-919-2544
Mailing Address - Fax:404-201-2159
Practice Address - Street 1:204 KENMAR DR STE 4
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1705
Practice Address - Country:US
Practice Address - Phone:844-992-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA170033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport