MEDICARE: STAR MOBILITY PROSTHETICS 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	:	1194559815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR MOBILITY PROSTHETICS LLC

Provider Business Mailing Address
First Line	:	1707 GRANDSTAND DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4707
Country	:	US
Telephone Number	:	210-251-3565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 GRANDSTAND DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4707
Country	:	US
Telephone Number	:	210-251-3565
Fax Number	:	210-239-2820

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JESSE BENITEZ JR.
Credential	:
Telephone Number	:	210-852-1664

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	08/27/2024

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