Provider Demographics
NPI:1568478378
Name:STAR ANESTHESIA, PA.
Entity Type:Organization
Organization Name:STAR ANESTHESIA, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-375-7790
Mailing Address - Street 1:3510 N LOOP 1604 E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2303
Mailing Address - Country:US
Mailing Address - Phone:210-375-7790
Mailing Address - Fax:210-979-9686
Practice Address - Street 1:3510 N 1604 E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2303
Practice Address - Country:US
Practice Address - Phone:210-375-7790
Practice Address - Fax:210-979-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095008103Medicaid
TX095008101Medicaid
TX0073BRMedicare UPIN
TX095008103Medicaid