Provider Demographics
NPI:1164723326
Name:STARS DME
Entity Type:Organization
Organization Name:STARS DME
Other - Org Name:STARS DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-271-4752
Mailing Address - Street 1:2017 N CONWAY AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2965
Mailing Address - Country:US
Mailing Address - Phone:956-271-4752
Mailing Address - Fax:956-271-4774
Practice Address - Street 1:2017 N CONWAY AVE
Practice Address - Street 2:STE B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2965
Practice Address - Country:US
Practice Address - Phone:956-271-4752
Practice Address - Fax:956-271-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6440770001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6440770001Medicare NSC