Provider Demographics
NPI:1902425093
Name:BLUE STAR REHABILITATION PLANO LLC
Entity Type:Organization
Organization Name:BLUE STAR REHABILITATION PLANO LLC
Other - Org Name:BLUE STAR FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-445-4134
Mailing Address - Street 1:800 W AIRPORT FWY # 959
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6312
Mailing Address - Country:US
Mailing Address - Phone:972-445-4134
Mailing Address - Fax:
Practice Address - Street 1:17754 PRESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5638
Practice Address - Country:US
Practice Address - Phone:972-476-9036
Practice Address - Fax:972-476-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1588051114OtherADDITIONAL ORGANIZATION NPI