1063428894 NPI number — STARSHIP ENTERPRISES-MEDICAL LTD

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 1063428894 NPI number — STARSHIP ENTERPRISES-MEDICAL LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STARSHIP ENTERPRISES-MEDICAL LTD
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:
AMERICAN MEDICAL PRODUCTS
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:
1063428894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 SLADES FERRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02726-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-672-3334
Provider Business Mailing Address Fax Number:
508-672-5387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 SLADES FERRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02726-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-672-3334
Provider Business Practice Location Address Fax Number:
508-672-5387
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRELLA
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-672-3334

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 345154 . This is a "BLUE CROSS PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AM02293 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3712-7 . This is a "BLUE CROSS PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 110028556 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1524399 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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