Provider Demographics
NPI:1184947368
Name:STAR STATE HEART, PLLC
Entity type:Organization
Organization Name:STAR STATE HEART, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEMAIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-709-8229
Mailing Address - Street 1:PO BOX 41239
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0021
Mailing Address - Country:US
Mailing Address - Phone:512-334-7876
Mailing Address - Fax:512-445-6095
Practice Address - Street 1:1008 RANCH ROAD 620 S
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5631
Practice Address - Country:US
Practice Address - Phone:512-334-7855
Practice Address - Fax:512-445-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6655207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty