Basic Information
| Provider Information | |||||||||
| NPI: | 1811378573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIVE STAR ER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6300 LA CALMA DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787523843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 E HIGHWAY 290 | ||||||||
| Address2: | |||||||||
| City: | DRIPPING SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786205300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812098921 | ||||||||
| FaxNumber: | 2812098930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | CONNER | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5124528533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | 160182 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
ID Information
| ID | Type | State | Issuer | Description | HH185E | 01 | TX | BCBS | OTHER |