Basic Information
| Provider Information | |||||||||
| NPI: | 1881770923 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLSTAR PARTNERS LP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ALL STAR MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 W. PECAN, #8 | ||||||||
| Address2: | |||||||||
| City: | PFLUGERVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122515977 | ||||||||
| FaxNumber: | 5122516017 | ||||||||
| Practice Location | |||||||||
| Address1: | 6894 ALAMO DOWNS PKWY | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782384535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107678004 | ||||||||
| FaxNumber: | 2107678024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 10/30/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GAGE | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
| AuthorizedOfficialMiddleName: | PRESTON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5122515977 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| 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 | 144175001 | 05 | TX | MEDICAID | 107662203 | 05 | TX | MEDICAID | 016039201 | 05 | TX | MEDICAID | 016039202 | 05 | TX | MEDICAID | 107662201 | 05 | TX | MEDICAID | 001002072 | 05 | TX | MEDICAID | 532674 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |