Provider Demographics
NPI:1194559815
Name:STAR MOBILITY PROSTHETICS LLC
Entity type:Organization
Organization Name:STAR MOBILITY PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-852-1664
Mailing Address - Street 1:1707 GRANDSTAND DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4707
Mailing Address - Country:US
Mailing Address - Phone:210-251-3565
Mailing Address - Fax:
Practice Address - Street 1:1707 GRANDSTAND DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4707
Practice Address - Country:US
Practice Address - Phone:210-251-3565
Practice Address - Fax:210-239-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies