Provider Demographics
NPI:1275027385
Name:STAR FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:STAR FAMILY MEDICINE PLLC
Other - Org Name:STAR FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-339-0362
Mailing Address - Street 1:933 HILLTOP DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-8808
Mailing Address - Country:US
Mailing Address - Phone:817-341-7670
Mailing Address - Fax:817-341-7678
Practice Address - Street 1:933 HILLTOP DR STE 100
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-341-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391429301Medicaid