Healthcare Provider Details

I. General information

NPI: 1528771078
Provider Name (Legal Business Name): HOSPITAL STAR MEDICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 26 199, COL. ALTABRISA
MERIDA MX
97133
MX

IV. Provider business mailing address

500 WESTOVER DR # 19593
SANFORD NC
27330-8941
US

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JAVIER EZQUERRA
Title or Position: MGR
Credential: MD
Phone: 888-449-7999