Provider Demographics
NPI:1457985822
Name:FIVE STAR MEDICAL TRANSPORTATIONLLC
Entity Type:Organization
Organization Name:FIVE STAR MEDICAL TRANSPORTATIONLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-408-7533
Mailing Address - Street 1:FIVE STAR MEDICAL TRANSPORTATION LLC
Mailing Address - Street 2:803 WOODBINE AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2326
Mailing Address - Country:US
Mailing Address - Phone:646-408-7533
Mailing Address - Fax:585-360-2124
Practice Address - Street 1:FIVE STAR MEDICAL TRANSPORTATION LLC
Practice Address - Street 2:803 WOODBINE AVE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2326
Practice Address - Country:US
Practice Address - Phone:646-408-7533
Practice Address - Fax:585-360-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04530118Medicaid