Provider Demographics
NPI:1093530347
Name:LONE STAR MED SPA AND HEALTH LLC
Entity type:Organization
Organization Name:LONE STAR MED SPA AND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-600-6925
Mailing Address - Street 1:1710 RUFE SNOW DR STE 120
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5501
Mailing Address - Country:US
Mailing Address - Phone:817-600-6925
Mailing Address - Fax:541-314-9619
Practice Address - Street 1:1710 RUFE SNOW DR STE 120
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5501
Practice Address - Country:US
Practice Address - Phone:817-600-6925
Practice Address - Fax:541-314-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care