Healthcare Provider Details

I. General information

NPI: 1093390643
Provider Name (Legal Business Name): STAR MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10716 CRUCES DR
OKLAHOMA CITY OK
73162-8204
US

IV. Provider business mailing address

10716 CRUCES DR
OKLAHOMA CITY OK
73162-8204
US

V. Phone/Fax

Practice location:
  • Phone: 405-400-6094
  • Fax:
Mailing address:
  • Phone: 405-400-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EMMANUEL EZEKWESILI NEBE
Title or Position: OWNER
Credential:
Phone: 405-400-6094