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General NPI Number Information
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NPI Number | 1881171072
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Entity Type | Organization
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Legal Business Name | ELITE-STAR MEDICAL TRANSPORT LLC.
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 08/04/2018
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Provider Practice Location Address
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Address Line | 2910 W LAKE MARY BLVD STE 101
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City | LAKE MARY
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State | FL
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Zip | 32746
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Country | US
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Telephone | 407-917-4548
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 W LAKE MARY BLVD STE 101
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City | LAKE MARY
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State | FL
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Zip | 32746-3498
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Country | US
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Telephone | 407-927-1492
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. ALIMOHAMED MANJI
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Credential |
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Telephone | 407-927-1564
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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 |
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License Number State |
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