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General NPI Number Information
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NPI Number | 1699097501
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Entity Type | Organization
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Legal Business Name | STAR DIAGNOSTICS LLC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 3724 FM 1960 RD W STE 300A
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City | HOUSTON
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State | TX
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Zip | 77068-3528
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Country | US
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Telephone | 832-457-8950
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Fax | 888-286-2292
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Provider Business Mailing Address
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Address Line | 3724 FM 1960 RD W STE 300A
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City | HOUSTON
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State | TX
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Zip | 77068-3528
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Country | US
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Telephone | 832-457-8950
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Fax | 888-286-2292
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Authorized Official
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Title or Position | AURTHORIZED OFFICIAL
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Name | JAN TELL
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Credential |
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Telephone | 832-457-8950
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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 | 108892
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License Number State | TX
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