1558902296 NPI number — RISING STAR MEDICALS LLC

Table of content: (NPI 1558902296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558902296 NPI number — RISING STAR MEDICALS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RISING STAR MEDICALS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDSAVE RX PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558902296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E RILEY ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78357-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-394-7002
Provider Business Practice Location Address Fax Number:
361-394-7003
Provider Enumeration Date:
10/03/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KAVURI
Authorized Official First Name:
NANDANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-620-7220

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150125 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".