Basic Information
| Provider Information | |||||||||
| NPI: | 1124041462 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLSTAR PARTNERS LP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ALL STAR MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1101 PECAN ST W STE 8 | ||||||||
| Address2: | |||||||||
| City: | PFLUGERVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786602607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122515977 | ||||||||
| FaxNumber: | 5122516017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 PECAN ST W STE 8 | ||||||||
| Address2: | |||||||||
| City: | PFLUGERVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786602607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122515977 | ||||||||
| FaxNumber: | 5122516017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YULE | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5124584589 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 001015004 | 01 | TX | MDCP - REGION 5 | OTHER | 144175001 | 05 | TX | MEDICAID | 001015009 | 01 | TX | MDCP - REGION 10 | OTHER | 016039201 | 05 | TX | MEDICAID | 107662205 | 05 | TX | MEDICAID | 532675 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 001015006 | 01 | TX | MDCP-REGION7 | OTHER | 001015007 | 01 | TX | MDCP - REGION 8 | OTHER | 001015010 | 01 | TX | MDCP - REGION 11 | OTHER | 107662201 | 05 | TX | MEDICAID | 001015008 | 01 | TX | MDCP - REGION 9 | OTHER | 016039202 | 05 | TX | MEDICAID | 515064 | 01 | TX | BLUE CROSS | OTHER | 107662204 | 05 | TX | MEDICAID | 107662206 | 05 | TX | MEDICAID | 107662203 | 05 | TX | MEDICAID | 532674 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 001015005 | 01 | TX | MDCP- REGION 6 | OTHER |