Provider Demographics
NPI:1710174289
Name:STAR EMS
Entity Type:Organization
Organization Name:STAR EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:956-262-8511
Mailing Address - Street 1:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-1551
Mailing Address - Country:US
Mailing Address - Phone:956-262-8511
Mailing Address - Fax:956-262-8770
Practice Address - Street 1:219 N BROADWAY
Practice Address - Street 2:STE B
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543
Practice Address - Country:US
Practice Address - Phone:956-262-8511
Practice Address - Fax:956-262-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10000723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192499501Medicaid
TXAMB916OtherBCBS
TX192499501Medicaid