All Star Medical Resources LLC

Key facts

NPI

1245924497

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Physician 208D00000X

Legal business name

ALL STAR MEDICAL RESOURCES LLC

Practice address

2626 S Rainbow Blvd # 203a
Las Vegas, NV 89146-4005

Phone

(877) 420-6372

NPI assigned

Jun 8, 2023

Organization subpart

No

Authorized official

Name

Taj Reyes

Title

Credentialing

Phone

(907) 891-7812

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 8, 2023.

{
    "created_epoch": "1686182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1245924497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 S RAINBOW BLVD # 203A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891464005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 S RAINBOW BLVD # 203A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891464005",
            "telephone_number": "877-420-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL STAR MEDICAL RESOURCES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "TAJ",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "907-891-7812"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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