Provider Demographics
NPI:1578814547
Name:MEDISTAR PROVIDER SERVICES, INC.
Entity Type:Organization
Organization Name:MEDISTAR PROVIDER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-489-7766
Mailing Address - Street 1:10039 BISSONNET ST STE 322
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7840
Mailing Address - Country:US
Mailing Address - Phone:713-489-7766
Mailing Address - Fax:713-489-3949
Practice Address - Street 1:10039 BISSONNET ST STE 322
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7840
Practice Address - Country:US
Practice Address - Phone:713-489-7766
Practice Address - Fax:713-489-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-30
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty