1558430330 NPI number — NORTHSTAR EMS, LLC

Table of content: (NPI 1558430330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558430330 NPI number — NORTHSTAR EMS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSTAR EMS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558430330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2526
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77347-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-548-7772
Provider Business Mailing Address Fax Number:
281-540-6669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2022 HUMBLE PLACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-5281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-548-7772
Provider Business Practice Location Address Fax Number:
281-540-6669
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
281-548-7772

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  300217 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8669637 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1430108 . This is a "TEXAS HEALTHSPRING" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 790587136 . This is a "TX CHILDRENS HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0007056-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10024740 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0007056-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 634626 . This is a "MEM HERMANN HEALTHCARE SY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8100015 . This is a "EVERCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AMB521 . This is a "AMB521" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: EVERCARE . This is a "8100015" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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