Provider Demographics
NPI:1871778175
Name:M-STAR ENTERPRISES, INC
Entity type:Organization
Organization Name:M-STAR ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-725-6295
Mailing Address - Street 1:602 W KATHRYN ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8462
Mailing Address - Country:US
Mailing Address - Phone:417-725-6295
Mailing Address - Fax:417-724-8450
Practice Address - Street 1:602 W KATHRYN ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8462
Practice Address - Country:US
Practice Address - Phone:417-725-6295
Practice Address - Fax:417-724-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6055970001Medicare NSC