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General NPI Number Information
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NPI Number | 1235192204
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Entity Type | Organization
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Legal Business Name | SILVER STAR MEDICAL SUPPLIES AND EQUIPMENT
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1106 CLAYTON LN 548W
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City | AUSTIN
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State | TX
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Zip | 78723-1066
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Country | US
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Telephone | 512-453-5511
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Fax | 512-380-9459
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Provider Business Mailing Address
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Address Line | 1106 CLAYTON LN STE 548W 548W
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City | AUSTIN
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State | TX
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Zip | 78723-2488
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Country | US
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Telephone | 512-453-5511
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Fax | 512-380-9459
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Authorized Official
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Title or Position | OWNER
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Name | SUNDAY EFFIONG
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Credential |
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Telephone | 512-453-5511
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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 | 0066378
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License Number State | TX
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