MEDICARE: FIVE STAR EMERGENCY PHYSICIANS PA

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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0051PV	OTHER	TX	BCBS
2	0016PL	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720138449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR EMERGENCY PHYSICIANS PA

Provider Business Mailing Address
First Line	:	6300 LA CALMA DR
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78752-3843
Country	:	US
Telephone Number	:	512-452-8533
Fax Number	:	512-452-9306

Provider Business Practice Location Address
First Line	:	850 W CENTRAL TEXAS EXPY
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1890
Country	:	US
Telephone Number	:	254-690-0900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAM ROBERTS
Credential	:	MD
Telephone Number	:	512-452-8533

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	05/08/2012

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Directions to “FIVE STAR EMERGENCY PHYSICIANS PA ” Practice Location

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