MEDICARE: ISREAL CORNELIUS HOLMES STAR OF DAVID

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343800000X	Secured Medical Transport (VAN)
2	172A00000X	Driver
3	347C00000X	Private Vehicle
4	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1053718296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISREAL CORNELIUS HOLMES STAR OF DAVID

Provider Business Mailing Address
First Line	:	3122 SPRINGDALE DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5101
Country	:	US
Telephone Number	:	832-275-2686
Fax Number	:	866-292-3523

Provider Business Practice Location Address
First Line	:	3122 SPRINGDALE DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5101
Country	:	US
Telephone Number	:	832-275-2686
Fax Number	:	866-292-3523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	02/22/2023

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Directions to “ ISREAL CORNELIUS HOLMES STAR OF DAVID” Practice Location

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