Provider Demographics
NPI:1912620121
Name:HEALTHSTAR CLINICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HEALTHSTAR CLINICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:T
Authorized Official - Last Name:PEYECHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-463-0848
Mailing Address - Street 1:9803 HIGHWAY 242 STE 200-265
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-4368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8340 GREENLEAF RIDGE WAY
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-1119
Practice Address - Country:US
Practice Address - Phone:240-463-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty