1386340206 NPI number — BLUE STAR AMBULANCE LLC

Table of content: (NPI 1386340206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386340206 NPI number — BLUE STAR AMBULANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE STAR AMBULANCE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386340206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800481
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-0481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-901-8334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 511 KM 0.6 BO. REAL ANON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-901-8334
Provider Business Practice Location Address Fax Number:
787-936-7428
Provider Enumeration Date:
02/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
PACHECO
Authorized Official First Name:
MAGALY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-202-2845

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PR . This is a "CSP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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