Provider Demographics
NPI:1457770133
Name:ALLSTAR TRANSPORT SERVICES, LLC
Entity Type:Organization
Organization Name:ALLSTAR TRANSPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-509-1440
Mailing Address - Street 1:5703 ALEXANDRIA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-8427
Mailing Address - Country:US
Mailing Address - Phone:901-509-1440
Mailing Address - Fax:
Practice Address - Street 1:5703 ALEXANDRIA LN
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-8427
Practice Address - Country:US
Practice Address - Phone:901-509-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801503492343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)