Healthcare Provider Details

I. General information

NPI: 1114100922
Provider Name (Legal Business Name): STAR MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 INTERNATIONAL DR SUITE 102
HOLLAND OH
43528-9411
US

IV. Provider business mailing address

7300 INTERNATIONAL DR SUITE 102
HOLLAND OH
43528-9412
US

V. Phone/Fax

Practice location:
  • Phone: 866-824-0203
  • Fax: 866-824-0203
Mailing address:
  • Phone: 866-824-0203
  • Fax: 866-824-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARCUS GLIMORE
Title or Position: OWNER
Credential: OT
Phone: 407-627-8010