MEDICARE: MEDSTAR SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	220	AR

General Provider Information

NPI Number	:	1205084993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72078-0339
Country	:	US
Telephone Number	:	501-982-5912
Fax Number	:	501-985-9912

Provider Business Practice Location Address
First Line	:	2003 OLD MILITARY RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-8734
Country	:	US
Telephone Number	:	501-982-5912
Fax Number	:	501-985-9912

Authorized Official
Title or Position	:	CEO
Name	:	ROGER HOSMAN
Credential	:
Telephone Number	:	501-982-5912

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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