Provider Demographics
NPI:1699418715
Name:HOSPITAL STAR MEDICA
Entity type:Organization
Organization Name:HOSPITAL STAR MEDICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:800-990-7827
Mailing Address - Street 1:500 WESTOVER DR # 19593
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-8941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE 26 - 199 COL. ALTABRISA
Practice Address - Street 2:
Practice Address - City:MERIDA
Practice Address - State:YUCATAN
Practice Address - Zip Code:97133
Practice Address - Country:MX
Practice Address - Phone:999-930-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SME001012R12OtherSTATE