Provider Demographics
NPI:1881171072
Name:ELITE-STAR MEDICAL TRANSPORT LLC.
Entity type:Organization
Organization Name:ELITE-STAR MEDICAL TRANSPORT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALIMOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-927-1564
Mailing Address - Street 1:2910 W LAKE MARY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3498
Mailing Address - Country:US
Mailing Address - Phone:407-927-1492
Mailing Address - Fax:
Practice Address - Street 1:2910 W LAKE MARY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-917-4548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)