Provider Demographics
NPI:1356719173
Name:DALLAS BLUE STAR INC
Entity type:Organization
Organization Name:DALLAS BLUE STAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-290-0292
Mailing Address - Street 1:777 S CENTRAL EXPY
Mailing Address - Street 2:1T
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7411
Mailing Address - Country:US
Mailing Address - Phone:972-290-0292
Mailing Address - Fax:972-677-7873
Practice Address - Street 1:777 S CENTRAL EXPY
Practice Address - Street 2:1T
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7411
Practice Address - Country:US
Practice Address - Phone:972-290-0292
Practice Address - Fax:972-677-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)