1386708857 NPI number — RAJ CLINICS PROFESSIONAL SERVICES CORPORATION

Table of content: DR. SHARON W STARK PHD, RN, APRN, BC (NPI 1528163532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386708857 NPI number — RAJ CLINICS PROFESSIONAL SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJ CLINICS PROFESSIONAL SERVICES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386708857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 LAKEVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGANSPORT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46947-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-732-1166
Provider Business Mailing Address Fax Number:
574-753-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 CHASE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-732-1166
Provider Business Practice Location Address Fax Number:
574-753-4117
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KALAPATAPU
Authorized Official First Name:
SITHA GITA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
574-732-1166

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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