| Protostar Llc | |
|
2080 N State Highway 360 Ste 230 Grand Prairie TX 75050-0900 | |
| (682) 888-1290 | |
| (940) 312-7805 |
| Full Name | Protostar Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2080 N State Highway 360 Ste 230, Grand Prairie, Texas |
| Authorized Official Name and Position | Ryan Kippes (CEO) |
| Authorized Official Contact | 2142894933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Protostar Llc 2080 N State Highway 360 Ste 230 Grand Prairie TX 75050-0900 Ph: (214) 289-4933 | Protostar Llc 2080 N State Highway 360 Ste 230 Grand Prairie TX 75050-0900 Ph: (682) 888-1290 |
| NPI Number | 1689138604 |
|---|---|
| Provider Enumeration Date | 01/23/2019 |
| Last Update Date | 01/23/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689138604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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