Provider Demographics
NPI:1124189204
Name:MEDSTAR EMS, INC
Entity Type:Organization
Organization Name:MEDSTAR EMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAYFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-539-9111
Mailing Address - Street 1:POB 747
Mailing Address - Street 2:#40 ROUTE 41
Mailing Address - City:WEST OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03890
Mailing Address - Country:US
Mailing Address - Phone:603-539-9111
Mailing Address - Fax:603-539-9074
Practice Address - Street 1:#40 ROUTE 41
Practice Address - Street 2:
Practice Address - City:WEST OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03890-0747
Practice Address - Country:US
Practice Address - Phone:603-539-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMEDS598900OtherBLUE CROSS
NHAM0005Medicare ID - Type Unspecified