Provider Demographics
NPI:1003283805
Name:STAR CLIPPER TRANSFERS
Entity Type:Organization
Organization Name:STAR CLIPPER TRANSFERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-669-3446
Mailing Address - Street 1:405 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-3029
Mailing Address - Country:US
Mailing Address - Phone:318-669-3446
Mailing Address - Fax:318-669-3446
Practice Address - Street 1:405 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-3029
Practice Address - Country:US
Practice Address - Phone:318-669-3446
Practice Address - Fax:318-669-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)