MEDICARE: STELLAR HEALTH LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1083485999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STELLAR HEALTH LLC

Provider Business Mailing Address
First Line	:	2020 N ACADEMY BLVD
Second Line	:	SUITE 261, #2618
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	571-442-4665
Fax Number	:	940-301-3550

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD
Second Line	:	SUITE 261, #2618
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	571-442-4665
Fax Number	:	940-301-3550

Authorized Official
Title or Position	:	OWNER
Name	:	STELLA SIMONE BERNARD
Credential	:	FNP
Telephone Number	:	571-442-4665

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/10/2024

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Directions to “STELLAR HEALTH LLC ” Practice Location

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