Provider Demographics
NPI:1982746830
Name:T-STAR, PC
Entity type:Organization
Organization Name:T-STAR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-570-8782
Mailing Address - Street 1:1563 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4401
Mailing Address - Country:US
Mailing Address - Phone:432-570-8782
Mailing Address - Fax:
Practice Address - Street 1:4610 N GARFIELD ST
Practice Address - Street 2:STE. B-5
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2663
Practice Address - Country:US
Practice Address - Phone:432-570-8782
Practice Address - Fax:432-683-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114411261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-6646Medicare ID - Type Unspecified