Provider Demographics
NPI:1407326911
Name:STAR MED SUPPLIES LLC
Entity Type:Organization
Organization Name:STAR MED SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-348-6651
Mailing Address - Street 1:1235 ANTIOCH PIKE UNIT B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3103
Mailing Address - Country:US
Mailing Address - Phone:615-348-6651
Mailing Address - Fax:
Practice Address - Street 1:1235 ANTIOCH PIKE UNIT B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3103
Practice Address - Country:US
Practice Address - Phone:615-348-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDMEHS7936OtherDMEHS