Provider Demographics
NPI:1053392753
Name:UNIONSTAR MEDICAL SUPPLIES & SERVICES
Entity type:Organization
Organization Name:UNIONSTAR MEDICAL SUPPLIES & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:IYAKINOABASI
Authorized Official - Middle Name:E
Authorized Official - Last Name:MBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-474-1770
Mailing Address - Street 1:720 E MAIN ST
Mailing Address - Street 2:STE D-5
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3105
Mailing Address - Country:US
Mailing Address - Phone:214-474-1770
Mailing Address - Fax:214-474-1771
Practice Address - Street 1:720 E MAIN ST
Practice Address - Street 2:STE D-5
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3105
Practice Address - Country:US
Practice Address - Phone:214-474-1770
Practice Address - Fax:214-474-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157357802Medicaid
TX157357801Medicaid
TX4640480001Medicare NSC