Provider Demographics
NPI:1760378194
Name:FIVE STAR PROFESSIONAL TRANSPORT LLC
Entity type:Organization
Organization Name:FIVE STAR PROFESSIONAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-673-8416
Mailing Address - Street 1:4131 UNIVERSITY BLVD S STE 12
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4352
Mailing Address - Country:US
Mailing Address - Phone:904-673-8416
Mailing Address - Fax:904-661-1916
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 12
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4352
Practice Address - Country:US
Practice Address - Phone:904-673-8416
Practice Address - Fax:904-661-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)