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General NPI Number Information
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NPI Number | 1609387885
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Entity Type | Organization
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Legal Business Name | ALL STAR MEDI'VAN LLC
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 6307 CORDILLERA DR
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City | KILLEEN
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State | TX
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Zip | 76549-6895
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Country | US
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Telephone | 847-401-9851
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Fax |
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Provider Business Mailing Address
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Address Line | 6307 CORDILLERA DR
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City | KILLEEN
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State | TX
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Zip | 76549-6895
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Country | US
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Telephone | 847-401-9851
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELISA RENEE ST GEORGE
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Credential |
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Telephone | 847-401-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | S53221679893
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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