Provider Demographics
NPI:1093230716
Name:LONE STAR MTC, INC.
Entity Type:Organization
Organization Name:LONE STAR MTC, INC.
Other - Org Name:LONE STAR MEDICAL TRANSPORTATION COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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 1:896 SUMMIT ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4370
Mailing Address - Country:US
Mailing Address - Phone:512-323-0160
Mailing Address - Fax:512-323-0165
Practice Address - Street 1:896 SUMMIT ST STE 106
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4370
Practice Address - Country:US
Practice Address - Phone:512-323-0160
Practice Address - Fax:512-323-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3745580Medicaid