Organization
STAR STATE HEART PLLC
Active
Other names
Star State Heart & Vascular PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL J. DEMAIO M.D. (OWNER)
(512) 263-0123
Entity
Organization
Contact information
Practice address
200 MEDICAL PKWY, SUITE 270, LAKEWAY, TX 78738-1782
(512) 263-0123
(512) 367-5841
Mailing address
PO BOX POX # 731393, DALLAS, TX 75373-1393
(512) 263-0123
(512) 367-5841
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G6655
TX
207RI0011X
Interventional Cardiology Physician
Primary
G6655
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134703111
MEDICAID
TX
01
—
211911702
MEDICAID
TX
01
—
8F24108
MEDICARE
TX
01
—
TXB144746
MEDICARE
TX
01
—
TXB144747
MEDICARE
TX
Enumeration date
01/26/2010
Last updated
11/08/2012
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