MEDICARE: STAR MEDICAL TRANSPORTATION INC

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)		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316119266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR MEDICAL TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	16004 BROADWAY AVE
Second Line	:	SUITE 206
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2557
Country	:	US
Telephone Number	:	216-659-6538
Fax Number	:

Provider Business Practice Location Address
First Line	:	16004 BROADWAY AVE
Second Line	:	SUITE 206
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2557
Country	:	US
Telephone Number	:	216-659-6538
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTWAIN LORENZO HAMILTON
Credential	:
Telephone Number	:	216-659-6538

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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