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General NPI Number Information
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NPI Number | 1114174307
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Entity Type | Organization
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Legal Business Name | NATIONAL MEDISTAR HEALTHCARE SOLUTIONS, LLC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 01/01/2011
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Provider Practice Location Address
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Address Line | 3220 W SOUTHLAKE BLVD SUITE P
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6752
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Country | US
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Telephone | 817-993-1093
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Fax | 817-993-0000
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Provider Business Mailing Address
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Address Line | 3220 W SOUTHLAKE BLVD SUITE P
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6752
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Country | US
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Telephone | 817-993-1093
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Fax | 817-993-0000
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Authorized Official
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Title or Position | OWNER
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Name | MR. KHALID ISLAM
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Credential | MBA
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Telephone | 817-993-1093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0105845
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License Number State | TX
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