1124041462 NPI number — ALLSTAR PARTNERS LP

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 1124041462 NPI number — ALLSTAR PARTNERS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLSTAR PARTNERS LP
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:
ALL STAR MEDICAL
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:
1124041462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 PECAN ST W STE 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PFLUGERVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78660-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-251-5977
Provider Business Mailing Address Fax Number:
512-251-6017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 PECAN ST W STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-251-5977
Provider Business Practice Location Address Fax Number:
512-251-6017
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YULE
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
512-458-4589

Provider Taxonomy Codes

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

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

  • Identifier: 001015004 . This is a "MDCP - REGION 5" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 144175001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001015009 . This is a "MDCP - REGION 10" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 016039201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 532675 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015006 . This is a "MDCP-REGION7" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015007 . This is a "MDCP - REGION 8" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015010 . This is a "MDCP - REGION 11" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 107662201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001015008 . This is a "MDCP - REGION 9" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 016039202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515064 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 107662204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 532674 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015005 . This is a "MDCP- REGION 6" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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