Provider Demographics
NPI:1528515988
Name:PRO STAR MEDICAL
Entity type:Organization
Organization Name:PRO STAR MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:NORRIS
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-996-5304
Mailing Address - Street 1:4100 SPRING VALLEY
Mailing Address - Street 2:SUITE 642
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3629
Mailing Address - Country:US
Mailing Address - Phone:888-586-7764
Mailing Address - Fax:214-279-9700
Practice Address - Street 1:4100 SPRING VALLEY
Practice Address - Street 2:SUITE 642
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:888-586-7764
Practice Address - Fax:214-279-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies