Provider Demographics
NPI:1669472767
Name:T-STAR PC
Entity Type:Organization
Organization Name:T-STAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-570-8782
Mailing Address - Street 1:4519 N GARFIELD ST
Mailing Address - Street 2:SUITES 5 & 4
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3400
Mailing Address - Country:US
Mailing Address - Phone:432-570-8782
Mailing Address - Fax:432-683-8476
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITES 5 & 4
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-570-8782
Practice Address - Fax:432-683-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1023430261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-6646Medicare ID - Type Unspecified
TX45-6646Medicare UPIN