Provider Demographics
NPI:1215113642
Name:LONE STAR PM & R GROUP, PA
Entity type:Organization
Organization Name:LONE STAR PM & R GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MULROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-616-9990
Mailing Address - Street 1:8601 VILLAGE DRIVE, STE 118
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-5509
Mailing Address - Country:US
Mailing Address - Phone:210-222-2606
Mailing Address - Fax:210-222-8410
Practice Address - Street 1:8500 VILLAGE DR STE 204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5510
Practice Address - Country:US
Practice Address - Phone:210-222-2606
Practice Address - Fax:210-222-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ83272081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127473005Medicaid
TX127473005Medicaid
TXG03367Medicare UPIN