Provider Demographics
NPI:1154328565
Name:MED STAR EMERGENCY MEDICAL SERVICES AND TRANSPORT INC
Entity Type:Organization
Organization Name:MED STAR EMERGENCY MEDICAL SERVICES AND TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES. / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-369-8084
Mailing Address - Street 1:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-0156
Mailing Address - Country:US
Mailing Address - Phone:330-369-8084
Mailing Address - Fax:330-369-8026
Practice Address - Street 1:1600 YOUNGSTOWN RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4251
Practice Address - Country:US
Practice Address - Phone:330-369-8084
Practice Address - Fax:330-369-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH780042341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0542514Medicaid
OH000000155568OtherANTHEM
OH=========01OtherMEDICAL MUTUAL
OH000000155568OtherANTHEM
OH9204221Medicare ID - Type Unspecified