MEDICARE: 5 STAR TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1265995831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	6540 DATE PALM BLVD APT 3
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-5505
Country	:	US
Telephone Number	:	727-366-8468
Fax Number	:

Provider Business Practice Location Address
First Line	:	6540 DATE PALM BLVD APT 3
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-5505
Country	:	US
Telephone Number	:	727-366-8468
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC DAVIS II
Credential	:
Telephone Number	:	727-366-8468

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	04/10/2019

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