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General NPI Number Information
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NPI Number | 1548208036
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Entity Type | Organization
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Legal Business Name | FIVE STAR MEDICAL SUPPLY INCORPORATED
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1123 BABCOCK RD STE. C
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City | SAN ANTONIO
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State | TX
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Zip | 78201-6917
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Country | US
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Telephone | 210-731-0500
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Fax | 210-736-3740
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Provider Business Mailing Address
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Address Line | 1123 BABCOCK RD STE. C
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City | SAN ANTONIO
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State | TX
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Zip | 78201-6917
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Country | US
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Telephone | 210-731-0500
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Fax | 210-736-3740
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. JOHN IJOMA EGEOLU III
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Credential |
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Telephone | 210-731-0500
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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 | 0088709
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License Number State | TX
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