Provider Demographics
NPI:1821405804
Name:LONE STAR SURGICAL SYSTEMS, INC. D.M.E. DIVISION
Entity type:Organization
Organization Name:LONE STAR SURGICAL SYSTEMS, INC. D.M.E. DIVISION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER #2
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:TRUMANE
Authorized Official - Last Name:MCMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-427-4393
Mailing Address - Street 1:PO BOX 151595
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75315-1595
Mailing Address - Country:US
Mailing Address - Phone:206-427-4393
Mailing Address - Fax:
Practice Address - Street 1:1700 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-5314
Practice Address - Country:US
Practice Address - Phone:214-565-0946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONE STAR SURGICAL SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001266332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies