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NPI Code Detail

MEDICARE: DAVID J STARK LSCSW

MEDICARE: DAVID J STARK LSCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker5836KS
21041C0700XClinical Social Worker053KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1830153OTHERKSBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1285686998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID J STARK LSCSW
Provider Business Mailing Address
First Line : 934 N WATER ST
Second Line :
City : WICHITA
State : KS
Zip : 67203-3838
Country : US
Telephone Number : 316-660-7600
Fax Number : 316-941-5075
Provider Business Practice Location Address
First Line : 940 N WACO AVE
Second Line :
City : WICHITA
State : KS
Zip : 67203-3947
Country : US
Telephone Number : 316-660-7550
Fax Number : 316-383-8241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 05/24/2016

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Directions to “ DAVID J STARK LSCSW” Practice Location

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