MEDICARE: STAR TRANSPORTATION SERVICES 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	343900000X	Non-emergency Medical Transport (VAN)	T25025014	VA

General Provider Information

NPI Number	:	1245775592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR TRANSPORTATION SERVICES LLC

Provider Business Mailing Address
First Line	:	6307 MACBETH CT
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-5875
Country	:	US
Telephone Number	:	804-275-7712
Fax Number	:	804-855-1799

Provider Business Practice Location Address
First Line	:	6307 MACBETH CT
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-5875
Country	:	US
Telephone Number	:	804-275-7712
Fax Number	:	804-855-1799

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHERROD LEON ELLIS
Credential	:
Telephone Number	:	804-275-7712

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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Directions to “STAR TRANSPORTATION SERVICES LLC ” Practice Location

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