Protostar LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PROTOSTAR LLC

Practice address

2080 N State Highway 360 Ste 230
Grand Prairie, TX 75050-0900

Phone

(682) 888-1290

Fax

(940) 312-7805

NPI assigned

Jan 23, 2019

Organization subpart

No

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

Authorized official

Name

Ryan Kippes

Title

Ceo

Phone

(214) 289-4933

Specialties & licenses 2

Addresses

Other names 1

• Servant's Heart Behavioral Health Clinic Doing business as

Locations

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1689138604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2080 N STATE HIGHWAY 360 STE 230",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750500900",
            "telephone_number": "214-289-4933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 N STATE HIGHWAY 360 STE 230",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750500900",
            "telephone_number": "682-888-1290",
            "fax_number": "940-312-7805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTOSTAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "KIPPES",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-289-4933"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Servant's Heart Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Multi-Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.