1033398219 NPI number — KIMBERLY S. STARKS AUD

Table of content: KIMBERLY S. STARKS AUD (NPI 1033398219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033398219 NPI number — KIMBERLY S. STARKS AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARKS
Provider First Name:
KIMBERLY
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
S.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033398219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 JACKSON PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-886-9370
Provider Business Mailing Address Fax Number:
740-886-9374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 TOWNSHIP ROAD 369
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROCTORVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45669-9133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-886-9370
Provider Business Practice Location Address Fax Number:
740-886-9374
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A.01577 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 310917085190 . This is a "OH MEDICAID CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00711132 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000259545 . This is a "OH MEDICAID UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3810011309 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0098592 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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