Provider Demographics
NPI:1265406854
Name:NORTHSTAR EMS, INC.
Entity type:Organization
Organization Name:NORTHSTAR EMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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:205-247-4748
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 1:6285 PARK SOUTH DR STE 200
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5670
Practice Address - Country:US
Practice Address - Phone:205-424-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1426539Medicaid
AL51051901OtherBCBS OF AL
AL000051901Medicaid
AL3684OtherHEALTHSPRING OF AL
TN0161517OtherBCBS OF TN
AL590013768OtherPALMETTO GOVT BENEFIT ADM
AL0172780OtherDEPT. OF LABOR
AL080027000OtherBLACK LUNG
AL3684OtherUMWA
MS00553248Medicaid
GA342319998AMedicaid
GA342319998AMedicaid