Provider Demographics
NPI:1568700359
Name:NORTH STAR MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:NORTH STAR MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:SLABOSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-932-9223
Mailing Address - Street 1:3111 WHEELOCK DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4553
Mailing Address - Country:US
Mailing Address - Phone:847-932-9223
Mailing Address - Fax:
Practice Address - Street 1:3111 WHEELOCK DR
Practice Address - Street 2:UNIT 3
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4553
Practice Address - Country:US
Practice Address - Phone:847-932-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)