Provider Demographics
NPI:1760759575
Name:BROADSTAR INSTALLS LLC
Entity Type:Organization
Organization Name:BROADSTAR INSTALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:804-247-4779
Mailing Address - Street 1:4801 OLD WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4723
Mailing Address - Country:US
Mailing Address - Phone:804-247-4779
Mailing Address - Fax:804-201-4877
Practice Address - Street 1:4801 OLD WARWICK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4723
Practice Address - Country:US
Practice Address - Phone:804-247-4779
Practice Address - Fax:804-201-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies