Provider Demographics
NPI:1154425874
Name:STARKEY MEDICAL PC
Entity type:Organization
Organization Name:STARKEY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NURSE PRACTITONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-7630
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-527-1788
Mailing Address - Fax:540-776-7631
Practice Address - Street 1:4903 STARKEY RD STE 300
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8525
Practice Address - Country:US
Practice Address - Phone:540-776-7630
Practice Address - Fax:540-773-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024125716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP0062019OtherMEDICARE RAILROAD
VAC08847Medicare ID - Type Unspecified
VAP0062019OtherMEDICARE RAILROAD
VAS48453Medicare UPIN