1033939863 NPI number — STAR ORTHOPEDICS AND SPORTS MEDICINE PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033939863 NPI number — STAR ORTHOPEDICS AND SPORTS MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR ORTHOPEDICS AND SPORTS MEDICINE PLLC
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:
Provider Other Organization Name Type Code:
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:
1033939863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 WARREN PKWY STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-7330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-616-4000
Provider Business Mailing Address Fax Number:
972-294-3343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 E STATE HIGHWAY 121 STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPPELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75019-7985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-850-0680
Provider Business Practice Location Address Fax Number:
469-850-0681
Provider Enumeration Date:
10/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DOLD
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
469-850-0680

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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