Provider Demographics
NPI:1699091041
Name:BRIGHT STAR MEDICAL TRANSPORT
Entity type:Organization
Organization Name:BRIGHT STAR MEDICAL TRANSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-537-3484
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-0546
Mailing Address - Country:US
Mailing Address - Phone:832-537-3484
Mailing Address - Fax:832-582-3672
Practice Address - Street 1:3830 QUIET PLACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1226
Practice Address - Country:US
Practice Address - Phone:832-537-3484
Practice Address - Fax:832-582-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000417341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN