Provider Demographics
NPI:1194804716
Name:STAR CPD SERVICES LLC
Entity type:Organization
Organization Name:STAR CPD SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:866-586-8919
Mailing Address - Street 1:511 COUNTY ROAD 3640
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-6917
Mailing Address - Country:US
Mailing Address - Phone:866-586-8919
Mailing Address - Fax:866-586-8918
Practice Address - Street 1:513 COUNTY ROAD 3640
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-3650
Practice Address - Country:US
Practice Address - Phone:866-586-8919
Practice Address - Fax:866-586-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTSP37OtherMULTISPECIALTY207RP1001X PULMONARY DISEASE, MULTISPEIALTY207RSO012XSLEEP MEDICIN