Provider Demographics
NPI:1780920058
Name:STARS AND STRIPES MEDICAL LLC
Entity type:Organization
Organization Name:STARS AND STRIPES MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:502-724-7883
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-0449
Mailing Address - Country:US
Mailing Address - Phone:502-724-7883
Mailing Address - Fax:502-290-1291
Practice Address - Street 1:301 W. STEPHEN FOSTER AVE
Practice Address - Street 2:SUITE B.
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-724-7883
Practice Address - Fax:502-290-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies