MEDICARE: STAR PRIMARY CARE, L.L.C.

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	207Q00000X	Family Medicine Physician	9009	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08015227	OTHER	NV	RAILROAD MEDICARE NUMBER

General Provider Information

NPI Number	:	1629265038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR PRIMARY CARE, L.L.C.

Provider Business Mailing Address
First Line	:	2645 W HORIZON RIDGE PKWY
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89052-2898
Country	:	US
Telephone Number	:	702-614-1800
Fax Number	:	702-614-1888

Provider Business Practice Location Address
First Line	:	2645 W HORIZON RIDGE PKWY
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89052-2898
Country	:	US
Telephone Number	:	702-614-1800
Fax Number	:	702-614-1888

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. STANLEY WILLIAM PIERCE JR.
Credential	:	M.D.
Telephone Number	:	702-614-1800

Provider Enumeration Date	:	09/29/2007
Last Update Date	:	05/07/2008

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Directions to “STAR PRIMARY CARE, L.L.C. ” Practice Location

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