MEDICARE: NORTHSTAR MEDICAL TRANSPORTATION 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1477261659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	811 SILVER DR
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 SILVER DR
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-8716
Country	:	US
Telephone Number	:	920-396-2511
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAI YANG
Credential	:
Telephone Number	:	608-860-0471

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	09/25/2023

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