MEDICARE: STAR MEDICAL D.M.E

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		TX

General Provider Information

NPI Number	:	1023217676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR MEDICAL D.M.E

Provider Business Mailing Address
First Line	:	PO BOX 4058
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-0058
Country	:	US
Telephone Number	:	214-682-2985
Fax Number	:	972-913-8510

Provider Business Practice Location Address
First Line	:	2305 DENMARK ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75253-3716
Country	:	US
Telephone Number	:	214-682-2985
Fax Number	:	972-913-8510

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JAMIE SAMANTHA LARA
Credential	:
Telephone Number	:	214-228-4390

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/21/2022

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