Basic Information
| Provider Information | |||||||||
| NPI: | 1083654479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIVE STAR PHYSICIAN SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2613 | ||||||||
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| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218022613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435485700 | ||||||||
| FaxNumber: | 4435485705 | ||||||||
| Practice Location | |||||||||
| Address1: | 9715 HEALTHWAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435485700 | ||||||||
| FaxNumber: | 4435485705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | SETTING | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4102790317 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208200000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 539702400 | 05 | MD | MEDICAID | 027430900 | 05 | DC | MEDICAID |