Active NPI
Star Formula Inc
- Parenteral & Enteral Nutrition Supplies (DME)
- Dallas, TX
National Provider Identifier
1669949046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Parenteral & Enteral Nutrition Supplies (DME)
- Legal business name
- STAR FORMULA INC
- Practice address
- 428 E Jefferson Blvd Ste 123
Dallas, TX 75203-5613 - Phone
- (214) 942-2862
- Fax
- (915) 942-2920
- NPI assigned
- Oct 24, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Greg L Jackson, AO
- Title
- Owner
- Phone
- (800) 368-2065
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | Primary |
Addresses
Primary practice location
428 E Jefferson Blvd Ste 123
Dallas, TX 75203-5613
Mailing address
4386 Sunbelt Dr
Addison, TX 75001-5611
Phone (972) 380-2065
Other names 1
- Star Medical Specialties
National Provider Directory
National Provider Directory- Tax ID family
- Star Formula Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Addison, TX
- NPI 1538511910
-
- Durable Medical Equipment & Medical Supplies
- El Paso, TX
- NPI 1720554108
-
- Durable Medical Equipment & Medical Supplies
- Albuquerque, NM
- NPI 1164108825
Locations
4386 Sunbelt Dr
Addison, TX 75001
Phone (972) 380-2065
428 E Jefferson Blvd
Ste 123
Dallas, TX 75203
Phone (214) 942-2862
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1540339200000",
"number": "1669949046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4386 SUNBELT DR",
"city": "ADDISON",
"state": "TX",
"postal_code": "750015611",
"telephone_number": "972-380-2065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 E JEFFERSON BLVD STE 123",
"city": "DALLAS",
"state": "TX",
"postal_code": "752035613",
"telephone_number": "214-942-2862",
"fax_number": "915-942-2920"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STAR FORMULA INC",
"organizational_subpart": "NO",
"enumeration_date": "2018-10-24",
"last_updated": "2018-10-24",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "GREG",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "800-368-2065",
"authorized_official_credential": "AO"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "332BP3500X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Star Medical Specialties",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.