MEDICARE: STARGOLD MEDIC TRANSPORT SERVICE

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)	86522	NV

General Provider Information

NPI Number	:	1265605083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARGOLD MEDIC TRANSPORT SERVICE

Provider Business Mailing Address
First Line	:	1717 STOCKER ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6870
Country	:	US
Telephone Number	:	702-642-4634
Fax Number	:	702-642-4879

Provider Business Practice Location Address
First Line	:	1717 STOCKER ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6870
Country	:	US
Telephone Number	:	702-642-4634
Fax Number	:	702-642-4879

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALFREDO AMON PASAOA
Credential	:	RN
Telephone Number	:	734-626-1889

Provider Enumeration Date	:	04/12/2008
Last Update Date	:	04/12/2008

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Directions to “STARGOLD MEDIC TRANSPORT SERVICE ” Practice Location

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