=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962736090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALI STARKES MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2009
-----------------------------------------------------
Last Update Date | 06/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8325 ELK GROVE FLORIN RD SUITE 800
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95829-9523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-501-0728
-----------------------------------------------------
Fax | 916-683-9604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3605 AGNETA CT
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-7408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-501-0728
-----------------------------------------------------
Fax | 916-683-9604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING ADMINSTRATOR
-----------------------------------------------------
Name | MARGARET KAPASI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-501-0728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------