1568696185 NPI number — CAPITAL TOXICOLOGY, LLC

Table of content: MICHAEL PHILLIP STARKEY CCC-A, MA (NPI 1396760807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568696185 NPI number — CAPITAL TOXICOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL TOXICOLOGY, LLC
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:
1568696185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9417 BRODIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78748-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-610-9955
Provider Business Mailing Address Fax Number:
512-610-9977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9417 BRODIE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78748-5602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-610-9955
Provider Business Practice Location Address Fax Number:
512-610-9977
Provider Enumeration Date:
05/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WISE
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
V.P. LABORATORY OPERATIONS
Authorized Official Telephone Number:
512-610-9955

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45D1099976 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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