Provider Demographics
NPI:1770766289
Name:RED STAR HOLDINGS INC.
Entity type:Organization
Organization Name:RED STAR HOLDINGS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-862-2580
Mailing Address - Street 1:13733 OFFICE PARK COURT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-862-2580
Mailing Address - Fax:727-862-9458
Practice Address - Street 1:13733 OFFICE PARK COURT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-862-2580
Practice Address - Fax:727-862-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256890000Medicaid
FLK3717Medicare PIN
FLG98035Medicare UPIN