Provider Demographics
NPI:1033683305
Name:FIVE STAR TRANSPORTATION LLC
Entity Type:Organization
Organization Name:FIVE STAR TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:V
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-906-3557
Mailing Address - Street 1:466 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4177
Mailing Address - Country:US
Mailing Address - Phone:601-906-3557
Mailing Address - Fax:
Practice Address - Street 1:466 SHADOWOOD DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4177
Practice Address - Country:US
Practice Address - Phone:601-906-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800530297OtherNONE EMERGENCY MEDICAL TRANSPORTATION