Provider Demographics
NPI:1023217676
Name:STAR MEDICAL D.M.E
Entity Type:Organization
Organization Name:STAR MEDICAL D.M.E
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-228-4390
Mailing Address - Street 1:PO BOX 4058
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-0058
Mailing Address - Country:US
Mailing Address - Phone:214-682-2985
Mailing Address - Fax:972-913-8510
Practice Address - Street 1:2305 DENMARK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-3716
Practice Address - Country:US
Practice Address - Phone:214-682-2985
Practice Address - Fax:972-913-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies