Provider Demographics
NPI:1700428331
Name:STAR SURGICAL SERVICES
Entity Type:Organization
Organization Name:STAR SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHWAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-312-2246
Mailing Address - Street 1:405 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-2229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1631 LANCASTER DR STE 240
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3586
Practice Address - Country:US
Practice Address - Phone:817-741-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center