Texas Star Med Clinic LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

TEXAS STAR MED CLINIC LLC

Practice address

4749 Fredericksburg Rd Ste a
San Antonio, TX 78229-4465

Phone

(830) 822-0328

NPI assigned

Jan 22, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Luke B Berry, MD

Title

Owner

Phone

(210) 977-8630

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1528658648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4749 FREDERICKSBURG RD STE A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294465",
            "telephone_number": "210-977-8630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 FREDERICKSBURG RD STE A",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294465",
            "telephone_number": "830-822-0328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10717 N May Ave",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731202620",
            "country_code": "US",
            "telephone_number": "210-997-8630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEXAS STAR MED CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-22",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "LUKE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-977-8630",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.