Provider Demographics
NPI:1114100922
Name:STAR MEDICAL LLC
Entity Type:Organization
Organization Name:STAR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:407-627-8010
Mailing Address - Street 1:7300 INTERNATIONAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9412
Mailing Address - Country:US
Mailing Address - Phone:866-824-0203
Mailing Address - Fax:866-824-0203
Practice Address - Street 1:7300 INTERNATIONAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9411
Practice Address - Country:US
Practice Address - Phone:866-824-0203
Practice Address - Fax:866-824-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6060030001Medicare NSC