Star Medical Clinic Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

STAR MEDICAL CLINIC INC.

Practice address

1217 Mellen St
Centralia, WA 98531-1175

Phone

(360) 740-8546

Fax

(866) 874-1472

NPI assigned

Oct 8, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Eric G Carlson

Title

President and Ceo

Phone

(360) 269-5541

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kurt W Kenoyer, PA-C

  • Physician Assistant
  • Vancouver, WA
  • NPI 1396780979
  NPD (past)

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356652800000",
    "number": "1790037224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 SE PROSPECT ST",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985324308",
            "telephone_number": "360-269-5541",
            "fax_number": "866-874-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 MELLEN ST",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311175",
            "telephone_number": "360-740-8546",
            "fax_number": "866-874-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-08",
        "last_updated": "2012-12-28",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "360-269-5541",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parker Staley, CAAR
• Ryan M Staley, R-AAC, CPC
• Theresa Marie Stanfield
• Johnathan Gregory Stanhope
• Randall Allan Stanhope
• Renate Jayne Starroff, LMHC
• Craig Merrill Stedham
• Glenn Othneil Steinhorst
• Tygh Andrew Stephens
• C David Stevens, D.D.S.

• Clinic/Center in Centralia, WA
• Providers in Centralia, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; 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.