Healthcare Provider Details

I. General information

NPI: 1841675980
Provider Name (Legal Business Name): FIVE STAR ER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 MANCHACA ROAD
AUSTIN TX
78749
US

IV. Provider business mailing address

6300 LA CALMA DR SUITE 200
AUSTIN TX
78752-3843
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-8533
  • Fax: 281-209-8930
Mailing address:
  • Phone: 512-452-8533
  • Fax: 281-209-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number160191
License Number StateTX

VIII. Authorized Official

Name: CHERYL CONNER
Title or Position: CEO
Credential:
Phone: 512-452-8533