Provider Demographics
NPI:1730300229
Name:TEXAS FAMILY & OCCUPATIONAL HEALTH SERVICES I INC
Entity Type:Organization
Organization Name:TEXAS FAMILY & OCCUPATIONAL HEALTH SERVICES I INC
Other - Org Name:STAR MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:VITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-572-8835
Mailing Address - Street 1:PO BOX 810478
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-0478
Mailing Address - Country:US
Mailing Address - Phone:214-572-8835
Mailing Address - Fax:972-759-1519
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-5753
Practice Address - Country:US
Practice Address - Phone:214-572-8835
Practice Address - Fax:972-759-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1546207L00000X
TX9883207Q00000X
TXJ7118208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178094201Medicaid
TX0076MDOtherBLUE SHIELD
TX178094201Medicaid