Provider Demographics
NPI:1245678408
Name:STAR TAXI TRANSPORTATION
Entity type:Organization
Organization Name:STAR TAXI TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-526-2711
Mailing Address - Street 1:34 PICKWICK AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3455
Mailing Address - Country:US
Mailing Address - Phone:804-526-2711
Mailing Address - Fax:
Practice Address - Street 1:34 PICKWICK AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3455
Practice Address - Country:US
Practice Address - Phone:804-526-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
VA20121738344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA344600000XMedicaid
VA343900000XMedicaid