MEDICARE: ALL STAR AMBULANCE SERVICE 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	341600000X	Ambulance	1000232	TX
2	3416L0300X	Land Ambulance	1000232	TX

General Provider Information

NPI Number	:	1336382100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL STAR AMBULANCE SERVICE LLC

Provider Business Mailing Address
First Line	:	5645 HILLCROFT ST
Second Line	:	SUITE 801
City	:	HOUSTON
State	:	TX
Zip	:	77036-2296
Country	:	US
Telephone Number	:	832-206-8417
Fax Number	:

Provider Business Practice Location Address
First Line	:	5645 HILLCROFT ST
Second Line	:	SUITE 801
City	:	HOUSTON
State	:	TX
Zip	:	77036-2296
Country	:	US
Telephone Number	:	832-206-8417
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY BROWN
Credential	:
Telephone Number	:	832-206-8414

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	01/28/2010

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