Provider Demographics
NPI:1497075279
Name:GOLD STAR EMS, LLC
Entity Type:Organization
Organization Name:GOLD STAR EMS, LLC
Other - Org Name:GOLD STAR AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-886-3666
Mailing Address - Street 1:PO BOX 72282
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2282
Mailing Address - Country:US
Mailing Address - Phone:229-886-3666
Mailing Address - Fax:866-396-1173
Practice Address - Street 1:201 BALDWIN DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4366
Practice Address - Country:US
Practice Address - Phone:229-886-3666
Practice Address - Fax:866-396-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport