Provider Demographics
NPI:1043320591
Name:ALL STARS LLC
Entity type:Organization
Organization Name:ALL STARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SOTELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-782-5200
Mailing Address - Street 1:300 E NOLANA LOOP
Mailing Address - Street 2:STE C
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9684
Mailing Address - Country:US
Mailing Address - Phone:956-782-5200
Mailing Address - Fax:956-782-5202
Practice Address - Street 1:300 E NOLANA LOOP
Practice Address - Street 2:STE C
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9684
Practice Address - Country:US
Practice Address - Phone:956-782-5200
Practice Address - Fax:956-782-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166433601Medicaid
TX166433602Medicaid
TX4992080001Medicare NSC