Provider Demographics
NPI:1083790703
Name:HEALTHSTAR MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:HEALTHSTAR MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EBERECHI
Authorized Official - Middle Name:URE
Authorized Official - Last Name:AGBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-778-0124
Mailing Address - Street 1:1417 N COCKRELL HILL RD STE 1O1A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-1308
Mailing Address - Country:US
Mailing Address - Phone:469-778-0124
Mailing Address - Fax:469-778-0118
Practice Address - Street 1:1417 N COCKRELL HILL RD STE 101A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1308
Practice Address - Country:US
Practice Address - Phone:469-778-0124
Practice Address - Fax:469-778-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008015251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012183Medicaid