Basic Information
| Provider Information | |||||||||
| NPI: | 1326130881 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JEFFREY T. STARKEY, M.D., INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 31 CONSERVATORY DR | ||||||||
| Address2: | |||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442034281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307537523 | ||||||||
| FaxNumber: | 3307539162 | ||||||||
| Practice Location | |||||||||
| Address1: | 31 CONSERVATORY DR | ||||||||
| Address2: | |||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442034281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307537523 | ||||||||
| FaxNumber: | 3307539162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 01/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | STARKEY | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3307537523 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35065272 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2817054 | 05 | OH | MEDICAID |