1881770923 NPI number — ALLSTAR PARTNERS LP

Table of content: (NPI 1881770923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881770923 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:
1881770923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 W. PECAN, #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:
78634
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:
6894 ALAMO DOWNS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78238-4535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-767-8004
Provider Business Practice Location Address Fax Number:
210-767-8024
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAGE
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
PRESTON
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
512-251-5977

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: 144175001 , 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: 016039201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016039202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001002072 , 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".




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