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General NPI Number Information
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NPI Number | 1477884740
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Entity Type | Organization
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Legal Business Name | STAR STATE HEART PLLC
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 200 MEDICAL PKWY SUITE 270
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City | LAKEWAY
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State | TX
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Zip | 78738-1782
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Country | US
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Telephone | 512-263-0123
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Fax | 512-367-5841
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Provider Business Mailing Address
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Address Line | PO BOX POX # 731393
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City | DALLAS
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State | TX
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Zip | 75373-1393
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Country | US
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Telephone | 512-263-0123
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Fax | 512-367-5841
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL J. DEMAIO
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Credential | M.D.
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Telephone | 512-263-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G6655
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | G6655
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License Number State | TX
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