MEDICARE: BLUE STAR HEALTH CARE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1649563396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE STAR HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	515 N RIDGE RD
Second Line	:	STE 100
City	:	WICHITA
State	:	KS
Zip	:	67212-6389
Country	:	US
Telephone Number	:	316-712-6104
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 N RIDGE RD
Second Line	:	STE 100
City	:	WICHITA
State	:	KS
Zip	:	67212-6389
Country	:	US
Telephone Number	:	316-712-6104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PANNA JEAN JONES
Credential	:	RN
Telephone Number	:	316-258-0840

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	06/05/2014

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