Provider Demographics
NPI:1063428894
Name:STARSHIP ENTERPRISES-MEDICAL LTD
Entity type:Organization
Organization Name:STARSHIP ENTERPRISES-MEDICAL LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:508-672-3334
Mailing Address - Street 1:132 SLADES FERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2822
Mailing Address - Country:US
Mailing Address - Phone:508-672-3334
Mailing Address - Fax:508-672-5387
Practice Address - Street 1:132 SLADES FERRY AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-2822
Practice Address - Country:US
Practice Address - Phone:508-672-3334
Practice Address - Fax:508-672-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA345154OtherBLUE CROSS PLANS
RIAM02293Medicaid
RI3712-7OtherBLUE CROSS PLANS
MA110028556Medicaid
MA1524399Medicaid
RI3712-7OtherBLUE CROSS PLANS