Provider Demographics
NPI:1134377062
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:A
Authorized Official - Last Name:SMELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-247-4748
Mailing Address - Street 1:P O 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 1:2328 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1118
Practice Address - Country:US
Practice Address - Phone:205-904-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106104Medicaid
AL106104Medicaid