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General NPI Number Information
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NPI Number | 1114915253
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Entity Type | Organization
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Legal Business Name | STAR VOLUNTEERS
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 503 6TH ST
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City | CHANNING
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State | MI
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Zip | 49815-0161
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Country | US
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Telephone | 906-542-9411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 161 503 6TH ST
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City | CHANNING
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State | MI
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Zip | 49815-0161
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Country | US
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Telephone | 906-542-9411
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CORY MICHAEL ROELL
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Credential |
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Telephone | 906-221-7718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 221003
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License Number State | MI
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