Provider Demographics
NPI:1801227475
Name:STAR MOBILITY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:STAR MOBILITY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-445-0754
Mailing Address - Street 1:5624 WOODSHIRE DR APT 6
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2988
Mailing Address - Country:US
Mailing Address - Phone:260-445-0754
Mailing Address - Fax:260-444-5754
Practice Address - Street 1:5624 WOODSHIRE DR APT 6
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2988
Practice Address - Country:US
Practice Address - Phone:260-445-0754
Practice Address - Fax:260-444-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN343128343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)