MEDICARE: ALL STAR ORTHOPEDIC & MEDICAL SUPPLIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1235433483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL STAR ORTHOPEDIC & MEDICAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	13644 NEUTRON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4410
Country	:	US
Telephone Number	:	469-364-6424
Fax Number	:	469-364-6423

Provider Business Practice Location Address
First Line	:	13644 NEUTRON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4410
Country	:	US
Telephone Number	:	469-364-6424
Fax Number	:	469-364-6423

Authorized Official
Title or Position	:	CEO
Name	:	YEFIM SOKIRYANSKY
Credential	:
Telephone Number	:	469-364-6424

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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