=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528749058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARMED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2023
-----------------------------------------------------
Last Update Date | 07/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 HURT ST
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24531-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-983-0173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1261 COBBLE POND WAY
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-6605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-983-0173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | MAJIDA ALQAZZAZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-983-0173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------