Provider Demographics
NPI:1992038012
Name:FIVE STAR LIMOUSINE LLC
Entity Type:Organization
Organization Name:FIVE STAR LIMOUSINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-484-9883
Mailing Address - Street 1:2346 S LYNHURST DR
Mailing Address - Street 2:STE E101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8621
Mailing Address - Country:US
Mailing Address - Phone:317-484-9880
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR
Practice Address - Street 2:STE E101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8621
Practice Address - Country:US
Practice Address - Phone:317-484-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37086344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200947240AMedicaid