Provider Demographics
NPI:1588638100
Name:NORTHSTAR EMS INC
Entity Type:Organization
Organization Name:NORTHSTAR EMS INC
Other - Org Name:NORTHSTAR PARAMEDIC SVCS-TALLADEGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SMELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-247-4748
Mailing Address - Street 1:PO BOX 2788
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2788
Mailing Address - Country:US
Mailing Address - Phone:205-752-5866
Mailing Address - Fax:205-345-7911
Practice Address - Street 1:520 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2263
Practice Address - Country:US
Practice Address - Phone:256-480-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3684OtherHEALTHSPRING OF AL
AL590013768OtherPALMETTO GOVT BENEFIT ADM
TN0161517OtherBCBS OF TN
AL051550258OtherBCBS OF AL
AL051550258Medicaid
AL0172780OtherDEPT OF LABOR & INDUSTRIE
AL080027000OtherBLACK LUNG
LA1426598Medicaid
GA342319998AMedicaid
MS00553812Medicaid
GA342319998AMedicaid