=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083502504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUGUSTINA STAR MEDICAL GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11811 NORTH FWY STE 222-1029
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-3245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-372-1410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11811 NORTH FWY STE 222-1029
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77060-3245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-372-1410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | EMMANUEL ADJEI-GYAMFI
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 646-372-1410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------