Provider Type Icon

STAR CLINIC LLC NPI 1932608106


NPI Information

NPI: 1932608106
Provider Name: STAR CLINIC LLC
Classification: Obstetrics & Gynecology - 207VF0040X
Entity Type: Organization

Specialization: Female Pelvic Medicine and Reconstructive Surgery

CLIA Number: 03D2147170

Address:
14155 N 83RD AVE
BUILDING 6
PEORIA, AZ
ZIP 85381
Phone: (623) 223-0689
Get Directions

STAR CLINIC LLC is a female pelvic medicine and reconstructive surgery obstetrics gynecology in Peoria, AZ. The provider is a subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them. STAR CLINIC LLC NPI is 1932608106. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

14155 N 83RD AVE
BUILDING 6
PEORIA, AZ
ZIP 85381
Phone: (623) 223-0689
Fax: (480) 289-2712

The provider's authorized official is Sharon Vanderham .
The authorized official title is Sr. Director Of Anesthesia Rcm and has the following contact phone number (480) 268-9195.

The CLIA number assigned to this NPI record is 03D2147170 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/2/2018 and was last updated on 4/3/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207L00000XAnesthesiology22281ARIZONANo
2207VF0040XObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery38152ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1335672MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.