Provider Demographics
NPI:1477643880
Name:NORTH STAR FAMILY MEDICINE P.A.
Entity Type:Organization
Organization Name:NORTH STAR FAMILY MEDICINE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-225-6345
Mailing Address - Street 1:7215 WYOMING SPGS
Mailing Address - Street 2:BUILDING 3 SUITE 700
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4312
Mailing Address - Country:US
Mailing Address - Phone:512-225-6345
Mailing Address - Fax:512-225-6344
Practice Address - Street 1:7215 WYOMING SPGS
Practice Address - Street 2:BLDG 3 SUITE 700
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4312
Practice Address - Country:US
Practice Address - Phone:512-225-6345
Practice Address - Fax:512-225-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
K4308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0046LEOtherBCBS
0046LEOtherBCBS
TX00829WMedicare PIN
H37791Medicare UPIN