MEDICARE: ED-STAR AMBULANCE SERVICE 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	3416L0300X	Land Ambulance	1000602	TX

General Provider Information

NPI Number	:	1316239601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ED-STAR AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	5855 SOVEREIGN DR
Second Line	:	STE D157
City	:	HOUSTON
State	:	TX
Zip	:	77036-2330
Country	:	US
Telephone Number	:	832-884-8674
Fax Number	:	866-892-4807

Provider Business Practice Location Address
First Line	:	5855 SOVEREIGN DR
Second Line	:	STE D157
City	:	HOUSTON
State	:	TX
Zip	:	77036-2330
Country	:	US
Telephone Number	:	832-884-8674
Fax Number	:	866-892-4807

Authorized Official
Title or Position	:	OWNER
Name	:	EDWIN IMOH
Credential	:
Telephone Number	:	832-884-8674

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/05/2011

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Directions to “ED-STAR AMBULANCE SERVICE INC ” Practice Location

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