MEDICARE: STAR DIAGNOSTICS 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	174400000X	Specialist	108892	TX

General Provider Information

NPI Number	:	1699097501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	3724 FM 1960 RD W STE 300A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3528
Country	:	US
Telephone Number	:	832-457-8950
Fax Number	:	888-286-2292

Provider Business Practice Location Address
First Line	:	3724 FM 1960 RD W STE 300A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3528
Country	:	US
Telephone Number	:	832-457-8950
Fax Number	:	888-286-2292

Authorized Official
Title or Position	:	AURTHORIZED OFFICIAL
Name	:	JAN TELL
Credential	:
Telephone Number	:	832-457-8950

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/18/2010

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Directions to “STAR DIAGNOSTICS LLC ” Practice Location

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