Provider Demographics
NPI:1326220088
Name:STAR PRIMARY CARE,PA
Entity Type:Organization
Organization Name:STAR PRIMARY CARE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-485-6322
Mailing Address - Street 1:2914 WICKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5982
Mailing Address - Country:US
Mailing Address - Phone:281-485-6322
Mailing Address - Fax:281-485-6306
Practice Address - Street 1:6516 BROADWAY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7880
Practice Address - Country:US
Practice Address - Phone:281-485-6322
Practice Address - Fax:281-485-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00975WMedicare PIN