Provider Demographics
NPI:1023092004
Name:MEDSTAR EMERGENCY MEDICAL SERVICE, LLC
Entity type:Organization
Organization Name:MEDSTAR EMERGENCY MEDICAL SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUNDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-943-8388
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-0700
Mailing Address - Country:US
Mailing Address - Phone:251-943-8388
Mailing Address - Fax:251-970-2092
Practice Address - Street 1:111 W CAMPHOR AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3519
Practice Address - Country:US
Practice Address - Phone:251-943-8388
Practice Address - Fax:251-970-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport