Provider Demographics
NPI:1699097501
Name:STAR DIAGNOSTICS LLC
Entity type:Organization
Organization Name:STAR DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AURTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-457-8950
Mailing Address - Street 1:3724 FM 1960 RD W STE 300A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3528
Mailing Address - Country:US
Mailing Address - Phone:832-457-8950
Mailing Address - Fax:888-286-2292
Practice Address - Street 1:3724 FM 1960 RD W STE 300A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3528
Practice Address - Country:US
Practice Address - Phone:832-457-8950
Practice Address - Fax:888-286-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty