Provider Demographics
NPI:1720052244
Name:NORTHSTAR EMS INC
Entity Type:Organization
Organization Name:NORTHSTAR EMS INC
Other - Org Name:NORTHSTAR PARAMEDIC SVCS-ST CLAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:205-345-0911
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 1:128 W PARK DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-4469
Practice Address - Country:US
Practice Address - Phone:205-424-1909
Practice Address - Fax:205-426-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051901Medicaid
51051901OtherBLUE CROSS
51051901OtherBLUE CROSS
TN0161517OtherBCBS OF TN
MS00553247Medicaid
AL0172780OtherDEPT OF LABOR & INDUSTRIE