Basic Information
Provider Information | |||||||||
NPI: | 1316023666 | ||||||||
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: | 11436 ROJAS DR | ||||||||
Address2: | SUITE B-6 | ||||||||
City: | EL PASO | ||||||||
State: | TX | ||||||||
PostalCode: | 799366471 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9156297174 | ||||||||
FaxNumber: | 9156297224 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/30/2006 | ||||||||
LastUpdateDate: | 10/03/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GAGE | ||||||||
AuthorizedOfficialFirstName: | ARTHUR | ||||||||
AuthorizedOfficialMiddleName: | PRESTON | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
AuthorizedOfficialTelephone: | 5122515977 | ||||||||
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 | 016039202 | 05 | TX |   | MEDICAID | 532675 | 01 | TX | BLUE CROSS | OTHER | 016039201 | 05 | TX |   | MEDICAID | 107662203 | 05 | TX |   | MEDICAID | 001002072 | 05 | TX |   | MEDICAID | 107662201 | 05 | TX |   | MEDICAID | 144175001 | 05 | TX |   | MEDICAID |