Provider Demographics
NPI:1427056332
Name:WEST STAR SURGICAL, P.A.
Entity type:Organization
Organization Name:WEST STAR SURGICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:915-921-8500
Mailing Address - Street 1:2150 TRAWOOD DR
Mailing Address - Street 2:STE A100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3322
Mailing Address - Country:US
Mailing Address - Phone:915-921-8500
Mailing Address - Fax:915-921-8505
Practice Address - Street 1:2150 TRAWOOD DR
Practice Address - Street 2:STE A100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3322
Practice Address - Country:US
Practice Address - Phone:915-921-8500
Practice Address - Fax:915-921-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13777208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E70868Medicare UPIN
TX00293TMedicare ID - Type Unspecified