1649316258 NPI number — STAR MED CONSULTING LLC

Table of content: (NPI 1649316258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649316258 NPI number — STAR MED CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR MED CONSULTING 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:
S WILLIAM PIERCE MD
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:
1649316258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 530880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89053-0880
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:
2645 W HORIZON RIDGE PKWY
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-2898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-648-9998
Provider Business Practice Location Address Fax Number:
702-648-9991
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
S WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER STARMED CONSULTING
Authorized Official Telephone Number:
702-648-9998

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  9009 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2018616 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2990225 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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