Provider Demographics
NPI:1558430330
Name:NORTHSTAR EMS, LLC
Entity Type:Organization
Organization Name:NORTHSTAR EMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-548-7772
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-2526
Mailing Address - Country:US
Mailing Address - Phone:281-548-7772
Mailing Address - Fax:281-540-6669
Practice Address - Street 1:2022 HUMBLE PLACE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5281
Practice Address - Country:US
Practice Address - Phone:281-548-7772
Practice Address - Fax:281-540-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3002173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8669637OtherCIGNA
TX1430108OtherTEXAS HEALTHSPRING
TX790587136OtherTX CHILDRENS HEALTH PLAN
TX0007056-02Medicaid
TX10024740OtherAMERIGROUP
TX0007056-01Medicaid
TX634626OtherMEM HERMANN HEALTHCARE SY
TX8100015OtherEVERCARE
TXAMB521OtherAMB521
TXEVERCAREOther8100015
TXAMB521OtherAMB521
TX0007056-01Medicaid