Provider Demographics
NPI:1922623966
Name:ALL STAR X-RAY, INC.
Entity Type:Organization
Organization Name:ALL STAR X-RAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-427-2768
Mailing Address - Street 1:7100 OAKMONT BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3911
Mailing Address - Country:US
Mailing Address - Phone:855-427-2768
Mailing Address - Fax:
Practice Address - Street 1:7100 OAKMONT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3911
Practice Address - Country:US
Practice Address - Phone:855-427-2768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL STAR X-RAY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory