1679511778 NPI number — STAR AMBULANCE SERVICE INC

Table of content: (NPI 1679511778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679511778 NPI number — STAR AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR AMBULANCE SERVICE INC
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:
1679511778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 3 BOX 17278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEBRADILLAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00678-9826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-408-0637
Provider Business Mailing Address Fax Number:
787-830-5404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROAD 457
Provider Second Line Business Practice Location Address:
BO PLANAS
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-408-0637
Provider Business Practice Location Address Fax Number:
787-830-5404
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
OMAR
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-408-0637

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC AMB 378 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50618 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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