MEDICARE: T-STAR PC

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	261Q00000X	Clinic/Center	1023430	TX

General Provider Information

NPI Number	:	1669472767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T-STAR PC

Provider Business Mailing Address
First Line	:	4519 N GARFIELD ST
Second Line	:	SUITES 5 & 4
City	:	MIDLAND
State	:	TX
Zip	:	79705-3400
Country	:	US
Telephone Number	:	432-570-8782
Fax Number	:	432-683-8476

Provider Business Practice Location Address
First Line	:	4519 N GARFIELD ST
Second Line	:	SUITES 5 & 4
City	:	MIDLAND
State	:	TX
Zip	:	79705-3415
Country	:	US
Telephone Number	:	432-570-8782
Fax Number	:	432-683-8476

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHIRLEY STAFFORD
Credential	:
Telephone Number	:	432-570-8782

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/02/2010

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Directions to “T-STAR PC ” Practice Location

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