Provider Demographics
NPI:1689730566
Name:STAR MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:STAR MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-593-2205
Mailing Address - Street 1:P.O. BOX 22954
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202
Mailing Address - Country:US
Mailing Address - Phone:615-365-3095
Mailing Address - Fax:615-365-3098
Practice Address - Street 1:976 MURFREESBORO PIKE
Practice Address - Street 2:#2200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217
Practice Address - Country:US
Practice Address - Phone:615-365-3095
Practice Address - Fax:615-365-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000234Medicaid