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General NPI Number Information
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NPI Number | 1609652981
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Entity Type | Organization
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Legal Business Name | NORTHERN STAR RIDE
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 11911 GREENVILLE AVE APT 2119
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City | DALLAS
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State | TX
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Zip | 75243-3665
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Country | US
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Telephone | 507-329-0167
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Fax |
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Provider Business Mailing Address
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Address Line | 11911 GREENVILLE AVE APT 2119
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City | DALLAS
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State | TX
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Zip | 75243-3665
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Country | US
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Telephone | 507-329-0167
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TEDROS KIROS BERIHU
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Credential |
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Telephone | 507-329-0167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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