Provider Demographics
NPI:1871101899
Name:BLUE STAR IMAGING SA, LLC
Entity type:Organization
Organization Name:BLUE STAR IMAGING SA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT TO COO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-497-4156
Mailing Address - Street 1:1 COWBOYS WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1995
Mailing Address - Country:US
Mailing Address - Phone:972-497-4156
Mailing Address - Fax:
Practice Address - Street 1:112 HERFF RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2747
Practice Address - Country:US
Practice Address - Phone:210-961-4282
Practice Address - Fax:210-961-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology