Provider Demographics
NPI:1801181946
Name:SOUTHERN STAR EMS INC
Entity Type:Organization
Organization Name:SOUTHERN STAR EMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENAJITE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-499-4787
Mailing Address - Street 1:650 IH 10 S
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4007
Mailing Address - Country:US
Mailing Address - Phone:409-499-4787
Mailing Address - Fax:
Practice Address - Street 1:650 IH 10 S
Practice Address - Street 2:SUITE 12
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4007
Practice Address - Country:US
Practice Address - Phone:409-499-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport