Healthcare Provider Details

I. General information

NPI: 1649316258
Provider Name (Legal Business Name): STAR MED CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 W HORIZON RIDGE PKWY STE 120
HENDERSON NV
89052-2898
US

IV. Provider business mailing address

PO BOX 530880
HENDERSON NV
89053-0880
US

V. Phone/Fax

Practice location:
  • Phone: 702-648-9998
  • Fax: 702-648-9991
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number9009
License Number StateNV

VIII. Authorized Official

Name: S WILLIAM PIERCE
Title or Position: OWNER STARMED CONSULTING
Credential:
Phone: 702-648-9998