MEDICARE: GOLD STAR 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	:	1588280614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD STAR TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2302 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4401
Country	:	US
Telephone Number	:	267-534-3656
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4401
Country	:	US
Telephone Number	:	267-534-3656
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GIOVANNI MARRERO
Credential	:
Telephone Number	:	267-423-8579

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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