Provider Demographics
NPI:1679525695
Name:STAR DIAGNOSTICS OF TARRANT COUNTY
Entity type:Organization
Organization Name:STAR DIAGNOSTICS OF TARRANT COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-943-9431
Mailing Address - Street 1:PO BOX 226656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-6656
Mailing Address - Country:US
Mailing Address - Phone:214-943-9431
Mailing Address - Fax:214-943-9407
Practice Address - Street 1:2100 N MAIN ST
Practice Address - Street 2:LL20
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-8570
Practice Address - Country:US
Practice Address - Phone:214-943-9431
Practice Address - Fax:214-943-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V5961OtherBCBS
TXFTSV01Medicare PIN