Provider Demographics
NPI:1619215753
Name:LONE STAR EVALUATIONS
Entity Type:Organization
Organization Name:LONE STAR EVALUATIONS
Other - Org Name:OCCUCARE INTERNATIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O. / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-476-0780
Mailing Address - Street 1:321 W SAN AUGUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4027
Mailing Address - Country:US
Mailing Address - Phone:281-476-0780
Mailing Address - Fax:281-476-0215
Practice Address - Street 1:3717 ROYAL MEADOWS ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6869
Practice Address - Country:US
Practice Address - Phone:409-722-0600
Practice Address - Fax:409-724-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB150233Medicare PIN