MEDICARE: STAR PAIN MANAGEMENT EQUIPMENT 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1104676386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR PAIN MANAGEMENT EQUIPMENT LLC

Provider Business Mailing Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4759
Country	:	US
Telephone Number	:	346-355-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4759
Country	:	US
Telephone Number	:	346-355-6616
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AMJID ALI
Credential	:
Telephone Number	:	346-355-6616

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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