MEDICARE: FIVE STAR MEDICAL SUPPLY INCORPORATED

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	0088709	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548208036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR MEDICAL SUPPLY INCORPORATED

Provider Business Mailing Address
First Line	:	1123 BABCOCK RD
Second Line	:	STE. C
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6917
Country	:	US
Telephone Number	:	210-731-0500
Fax Number	:	210-736-3740

Provider Business Practice Location Address
First Line	:	1123 BABCOCK RD
Second Line	:	STE. C
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6917
Country	:	US
Telephone Number	:	210-731-0500
Fax Number	:	210-736-3740

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. JOHN IJOMA EGEOLU III
Credential	:
Telephone Number	:	210-731-0500

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/02/2008

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Directions to “FIVE STAR MEDICAL SUPPLY INCORPORATED ” Practice Location

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