Provider Demographics
NPI:1972939189
Name:PRIME STAR A TRANSPORTATION INC
Entity Type:Organization
Organization Name:PRIME STAR A TRANSPORTATION INC
Other - Org Name:PRIME STAR TRANSPORTATION INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAIVISHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-444-4404
Mailing Address - Street 1:27 TOMLINSON RD
Mailing Address - Street 2:114
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19115
Mailing Address - Country:US
Mailing Address - Phone:267-444-4404
Mailing Address - Fax:
Practice Address - Street 1:27 TOMLINSON RD
Practice Address - Street 2:114
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4218
Practice Address - Country:US
Practice Address - Phone:267-444-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4210600341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance