Provider Demographics
NPI:1902900244
Name:STAR CARE FAMILY & PREVENTIVE MEDICINE
Entity Type:Organization
Organization Name:STAR CARE FAMILY & PREVENTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-594-1111
Mailing Address - Street 1:1701 W WALNUT HILL LANE
Mailing Address - Street 2:200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3215
Mailing Address - Country:US
Mailing Address - Phone:972-594-1111
Mailing Address - Fax:972-518-1867
Practice Address - Street 1:1701 W WALNUT HILL LANE
Practice Address - Street 2:200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3215
Practice Address - Country:US
Practice Address - Phone:972-594-1111
Practice Address - Fax:972-518-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G80529Medicare UPIN