Healthcare Provider Details

I. General information

NPI: 1073685434
Provider Name (Legal Business Name): MEDSTAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BUSINESS PARK WAY SUITE 100
SACRAMENTO CA
95828-0963
US

IV. Provider business mailing address

PO BOX 292007
SACRAMENTO CA
95829-2007
US

V. Phone/Fax

Practice location:
  • Phone: 916-669-0550
  • Fax: 916-669-0363
Mailing address:
  • Phone: 916-669-0550
  • Fax: 916-669-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ADAM C RUGGLES
Title or Position: CFO
Credential:
Phone: 916-669-0550