MEDICARE: DESERT STAR SHUTTLE SERVICES

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)

General Provider Information

NPI Number	:	1396059283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT STAR SHUTTLE SERVICES

Provider Business Mailing Address
First Line	:	1109 LOMALAND DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-1402
Country	:	US
Telephone Number	:	915-539-6998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 LOMALAND DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-1402
Country	:	US
Telephone Number	:	915-539-6998
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICARDO VALENZUELA
Credential	:
Telephone Number	:	915-539-6998

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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