Provider Demographics
NPI:1134193717
Name:NORTHSTAR EMS, INC.
Entity type:Organization
Organization Name:NORTHSTAR EMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SMELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-752-5866
Mailing Address - Street 1:PO BOX 2788
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2788
Mailing Address - Country:US
Mailing Address - Phone:205-752-5866
Mailing Address - Fax:205-345-7911
Practice Address - Street 1:2106 17TH AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5770
Practice Address - Country:US
Practice Address - Phone:205-752-5866
Practice Address - Fax:205-345-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0161517OtherBCBS OF TN PROVIDER NUMBE
MS00553245Medicaid
AL0172780OtherDEPT OF LABOR
AL51051892OtherBCBS OF ALABAMA
AL000051892Medicaid
LA1426555Medicaid
AL590013768OtherPALMETTO GOVT BENEFIT ADM
GA342319998AMedicaid
GA342319998AMedicaid