Provider Demographics
NPI:1629265038
Name:STAR PRIMARY CARE, L.L.C.
Entity Type:Organization
Organization Name:STAR PRIMARY CARE, L.L.C.
Other - Org Name:STAR FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-614-1800
Mailing Address - Street 1:2645 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2898
Mailing Address - Country:US
Mailing Address - Phone:702-614-1800
Mailing Address - Fax:702-614-1888
Practice Address - Street 1:2645 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2898
Practice Address - Country:US
Practice Address - Phone:702-614-1800
Practice Address - Fax:702-614-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-29
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV08015227OtherRAILROAD MEDICARE NUMBER
NV08015227OtherRAILROAD MEDICARE NUMBER
NVG95690Medicare UPIN