Provider Demographics
NPI:1568023521
Name:STAR MOBILITY PROSTHETICS LLC
Entity Type:Organization
Organization Name:STAR MOBILITY PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-852-1664
Mailing Address - Street 1:9471 CELINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5080
Mailing Address - Country:US
Mailing Address - Phone:210-852-1664
Mailing Address - Fax:
Practice Address - Street 1:27027 WESTHEIMER PKWY STE 1500
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5500
Practice Address - Country:US
Practice Address - Phone:832-913-8261
Practice Address - Fax:832-913-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier