Provider Demographics
NPI:1659760031
Name:FIVE STAR MEDICAL INC
Entity Type:Organization
Organization Name:FIVE STAR MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELSALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-5770
Mailing Address - Street 1:2313 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-4826
Mailing Address - Country:US
Mailing Address - Phone:318-443-5770
Mailing Address - Fax:
Practice Address - Street 1:2313 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-4826
Practice Address - Country:US
Practice Address - Phone:318-443-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA008205125OtherDRIVER'S LICENSE NUMBER
LA=========OtherTAX ID NUMBER