MEDICARE: FIVE STAR 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1902108988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR LLC

Provider Business Mailing Address
First Line	:	3297 ROXMERE DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1735
Country	:	US
Telephone Number	:	727-278-9265
Fax Number	:

Provider Business Practice Location Address
First Line	:	3297 ROXMERE DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1735
Country	:	US
Telephone Number	:	727-278-9265
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KAMAL NASSER
Credential	:
Telephone Number	:	727-789-2653

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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Directions to “FIVE STAR LLC ” Practice Location

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