Provider Demographics
NPI:1558715227
Name:EVERSTAR MEDICAL, LLLP
Entity Type:Organization
Organization Name:EVERSTAR MEDICAL, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-686-9748
Mailing Address - Street 1:2430 FRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5831
Mailing Address - Country:US
Mailing Address - Phone:281-829-3999
Mailing Address - Fax:
Practice Address - Street 1:2430 FRY RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5831
Practice Address - Country:US
Practice Address - Phone:281-829-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9188261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care