Provider Demographics
NPI:1265605083
Name:STARGOLD MEDIC TRANSPORT SERVICE
Entity type:Organization
Organization Name:STARGOLD MEDIC TRANSPORT SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:AMON
Authorized Official - Last Name:PASAOA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:734-626-1889
Mailing Address - Street 1:1717 STOCKER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6870
Mailing Address - Country:US
Mailing Address - Phone:702-642-4634
Mailing Address - Fax:702-642-4879
Practice Address - Street 1:1717 STOCKER ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6870
Practice Address - Country:US
Practice Address - Phone:702-642-4634
Practice Address - Fax:702-642-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV86522343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)