Provider Demographics
NPI:1316239601
Name:ED-STAR AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:ED-STAR AMBULANCE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-884-8674
Mailing Address - Street 1:5855 SOVEREIGN DR
Mailing Address - Street 2:STE D157
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2330
Mailing Address - Country:US
Mailing Address - Phone:832-884-8674
Mailing Address - Fax:866-892-4807
Practice Address - Street 1:5855 SOVEREIGN DR
Practice Address - Street 2:STE D157
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2330
Practice Address - Country:US
Practice Address - Phone:832-884-8674
Practice Address - Fax:866-892-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport