Provider Demographics
NPI:1407121429
Name:MEDISTAR INC
Entity Type:Organization
Organization Name:MEDISTAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-981-0824
Mailing Address - Street 1:106 ROSEHALL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-6235
Mailing Address - Country:US
Mailing Address - Phone:815-981-0824
Mailing Address - Fax:
Practice Address - Street 1:106 ROSEHALL DR
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-6235
Practice Address - Country:US
Practice Address - Phone:815-981-0824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)