Provider Demographics
NPI:1215546932
Name:5 STAR MEDICAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:5 STAR MEDICAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-327-0110
Mailing Address - Street 1:3160 W SAHARA AVE
Mailing Address - Street 2:STE A11B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3215
Mailing Address - Country:US
Mailing Address - Phone:702-900-5616
Mailing Address - Fax:702-446-6586
Practice Address - Street 1:3160 W SAHARA AVE STE A11B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6003
Practice Address - Country:US
Practice Address - Phone:702-900-5616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215546932Medicaid
NV1720697139Medicaid