Provider Demographics
NPI:1114915253
Name:STAR VOLUNTEERS
Entity Type:Organization
Organization Name:STAR VOLUNTEERS
Other - Org Name:STAR AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-221-7718
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:503 6TH ST
Mailing Address - City:CHANNING
Mailing Address - State:MI
Mailing Address - Zip Code:49815-0161
Mailing Address - Country:US
Mailing Address - Phone:906-542-9411
Mailing Address - Fax:
Practice Address - Street 1:503 6TH ST
Practice Address - Street 2:
Practice Address - City:CHANNING
Practice Address - State:MI
Practice Address - Zip Code:49815-0161
Practice Address - Country:US
Practice Address - Phone:906-542-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI221003341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
0B20004Medicare ID - Type Unspecified