MEDICARE: BLUE STAR MEDICAL MANAGEMENT PLLC

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1215458419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE STAR MEDICAL MANAGEMENT PLLC

Provider Business Mailing Address
First Line	:	3160 N TARRANT PKWY
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-8614
Country	:	US
Telephone Number	:	972-707-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 N TARRANT PKWY
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76177-8614
Country	:	US
Telephone Number	:	972-707-0005
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARK C VALENTE
Credential	:
Telephone Number	:	214-384-1642

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	07/21/2022

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