Provider Demographics
NPI:1942670195
Name:STAR PHYSICIANS GROUP LLC.
Entity Type:Organization
Organization Name:STAR PHYSICIANS GROUP LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-404-6641
Mailing Address - Street 1:2500 E PRICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3398
Mailing Address - Country:US
Mailing Address - Phone:239-404-6641
Mailing Address - Fax:817-573-9821
Practice Address - Street 1:100 E ALTON GLOOR BLVD # A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3328
Practice Address - Country:US
Practice Address - Phone:239-404-6641
Practice Address - Fax:817-573-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX475304Medicare PIN
AK028ZMedicare PIN
TX280965600Medicaid