Provider Demographics
NPI:1316119266
Name:STAR MEDICAL TRANSPORTATION INC
Entity type:Organization
Organization Name:STAR MEDICAL TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTWAIN
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-659-6538
Mailing Address - Street 1:16004 BROADWAY AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2557
Mailing Address - Country:US
Mailing Address - Phone:216-659-6538
Mailing Address - Fax:
Practice Address - Street 1:16004 BROADWAY AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2557
Practice Address - Country:US
Practice Address - Phone:216-659-6538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2709359Medicaid