Provider Demographics
NPI:1548334246
Name:MED STAR PARAMEDIC INC
Entity type:Organization
Organization Name:MED STAR PARAMEDIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-582-6096
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:922 E REDWOOD BLVD
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005
Mailing Address - Country:US
Mailing Address - Phone:605-582-6096
Mailing Address - Fax:605-582-8983
Practice Address - Street 1:922 E REDWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005
Practice Address - Country:US
Practice Address - Phone:605-582-6096
Practice Address - Fax:605-582-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 3416L0300X
SD0015146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9011110Medicaid
SDS8414Medicare PIN