Organization
GREG L JACKSON
Active
Other names
Star Medical Specialties
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG L JACKSON (CEO)
(972) 380-2065
Entity
Organization
Contact information
Practice address
4386 SUNBELT DR, ADDISON, TX 75001
(972) 380-2065
(972) 380-9488
Mailing address
4386 SUNBELT DR, ADDISON, TX 75001
(972) 380-2065
(972) 380-9488
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010118001
MEDICAID CCP
TX
05
—
011564401
—
TX
01
—
0519596
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/01/2006
Last updated
10/24/2018
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