1275665473 NPI number — RICHARD FREDRICK STARKEY MD

Table of content: (NPI 1275665473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275665473 NPI number — RICHARD FREDRICK STARKEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD FREDRICK STARKEY MD
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:
1275665473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N 6TH E
Provider Second Line Business Mailing Address:
PO BOX 427
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83647-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-587-9736
Provider Business Mailing Address Fax Number:
208-587-7905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 NORTH 6TH EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83647-0427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-587-9736
Provider Business Practice Location Address Fax Number:
208-587-7905
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STARKEY
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
FREDERICK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-587-9736

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP382A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 805234400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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