Provider Demographics
NPI:1801061734
Name:MEDSTAR HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:MEDSTAR HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-671-2828
Mailing Address - Street 1:5712 MCKINLEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4098
Mailing Address - Country:US
Mailing Address - Phone:972-671-2828
Mailing Address - Fax:972-671-4348
Practice Address - Street 1:5712 MCKINLEY LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4098
Practice Address - Country:US
Practice Address - Phone:972-671-2828
Practice Address - Fax:972-671-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health