Provider Demographics
NPI:1568514347
Name:STARR MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:STARR MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-689-9117
Mailing Address - Street 1:394 E MOANA LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4674
Mailing Address - Country:US
Mailing Address - Phone:775-689-9117
Mailing Address - Fax:775-827-6715
Practice Address - Street 1:394 E MOANA LN
Practice Address - Street 2:SUITE 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4674
Practice Address - Country:US
Practice Address - Phone:775-689-9117
Practice Address - Fax:775-827-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36470Medicare PIN