1386640035 NPI number — KINDSTAR, INC.

Table of content: (NPI 1386640035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386640035 NPI number — KINDSTAR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDSTAR, INC.
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:
6
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:
1386640035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 W MULBERRY ST STE 102
Provider Second Line Business Mailing Address:
ATTN MECCA
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76201-6011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-220-2074
Provider Business Mailing Address Fax Number:
844-595-5182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 N INTERSTATE 35
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-238-6000
Provider Business Practice Location Address Fax Number:
512-238-9559
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
DENA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AO/SECRETARY
Authorized Official Telephone Number:
972-201-3819

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009343 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 173200001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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