Healthcare Provider Details

I. General information

NPI: 1104155803
Provider Name (Legal Business Name): LONE STAR MEDICAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W ROYAL LN STE 196
IRVING TX
75063-1996
US

IV. Provider business mailing address

5005 W ROYAL LN STE 196
IRVING TX
75063-1996
US

V. Phone/Fax

Practice location:
  • Phone: 817-485-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE LYNCH
Title or Position: MANAGER
Credential:
Phone: 214-235-2116