Provider Demographics
NPI:1619674637
Name:STAR PEDIATRIC CARE
Entity type:Organization
Organization Name:STAR PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-209-9945
Mailing Address - Street 1:128 WERTZ AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4196
Mailing Address - Country:US
Mailing Address - Phone:330-621-0553
Mailing Address - Fax:
Practice Address - Street 1:128 WERTZ AVE NW STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4196
Practice Address - Country:US
Practice Address - Phone:330-621-0553
Practice Address - Fax:234-444-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
No291U00000XLaboratoriesClinical Medical Laboratory