Provider Demographics
NPI:1073003869
Name:MAVSTAR MEDICAL TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:MAVSTAR MEDICAL TRANSPORTATION, INC.
Other - Org Name:MAVERICK MEDICAL TRANSPORTATION COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:1606 W WHISPERING WIND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-1322
Mailing Address - Country:US
Mailing Address - Phone:817-380-6400
Mailing Address - Fax:817-380-6405
Practice Address - Street 1:1612 S BROADWAY, BUILDING 2, STE. 200
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-8915
Practice Address - Country:US
Practice Address - Phone:469-892-0024
Practice Address - Fax:817-380-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)