Provider Demographics
NPI:1205032620
Name:STAR MEDICAL INCORPORATED
Entity Type:Organization
Organization Name:STAR MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-980-4343
Mailing Address - Street 1:1023 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3016
Mailing Address - Country:US
Mailing Address - Phone:803-980-4343
Mailing Address - Fax:803-980-1726
Practice Address - Street 1:1023 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3016
Practice Address - Country:US
Practice Address - Phone:803-980-4343
Practice Address - Fax:803-980-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2803Medicaid
SC1245245828Medicare ID - Type UnspecifiedN.S.C