Provider Demographics
NPI:1629749478
Name:FIVE STAR INFUSION LLC
Entity Type:Organization
Organization Name:FIVE STAR INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON-BRUMFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-943-3031
Mailing Address - Street 1:1112 N FLOYD RD STE 9
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4243
Mailing Address - Country:US
Mailing Address - Phone:469-943-3031
Mailing Address - Fax:
Practice Address - Street 1:9550 SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4123
Practice Address - Country:US
Practice Address - Phone:469-941-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy