=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841119286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONE STAR MEDICAL SERVICES OF TEXAS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 DALLAS ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78205-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-297-7650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4535 DRESSLER RD NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-493-4443
-----------------------------------------------------
Fax | 330-493-8677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, RCM OPERATIONS
-----------------------------------------------------
Name | JENNIFER CHASTAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-994-4430
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------