Provider Demographics
NPI:1053829481
Name:STAR MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:STAR MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:CELINE
Authorized Official - Last Name:BENAVIDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-771-7808
Mailing Address - Street 1:6802 RINGGOLD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-4256
Mailing Address - Country:US
Mailing Address - Phone:423-771-7808
Mailing Address - Fax:
Practice Address - Street 1:6802 RINGGOLD RD STE 105
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-4256
Practice Address - Country:US
Practice Address - Phone:423-771-7808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies