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General NPI Number Information
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NPI Number | 1225573603
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Entity Type | Organization
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Legal Business Name | SILVER STAR MEDICAL RESOURCES, LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 1905 W ENNIS AVE STE 500
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City | ENNIS
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State | TX
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Zip | 75119-3627
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Country | US
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Telephone | 214-442-8908
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Fax | 214-442-8907
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Provider Business Mailing Address
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Address Line | PO BOX 821868
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City | DALLAS
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State | TX
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Zip | 75382-1868
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Country | US
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Telephone |
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Fax | 214-442-8907
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Authorized Official
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Title or Position | ADMIN
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Name | JAMIE L HELLMAN
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Credential |
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Telephone | 214-442-8908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | Q0036
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License Number State | TX
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