Provider Demographics
NPI:1568548956
Name:ASTAR MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ASTAR MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GILLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-826-2009
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-1183
Mailing Address - Country:US
Mailing Address - Phone:979-826-2009
Mailing Address - Fax:979-826-2022
Practice Address - Street 1:225 HIGHWAY 290 BUSINESS EAST
Practice Address - Street 2:SUITE B
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445
Practice Address - Country:US
Practice Address - Phone:979-826-2009
Practice Address - Fax:979-826-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0051704332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143005001Medicaid
TX143005001Medicaid