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NPI Code Detail

MEDICARE: DANA STARK PA

MEDICARE: DANA STARK PA
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
1363A00000XPhysician Assistant0673SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750554895
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA STARK PA
Provider Business Mailing Address
First Line : PO BOX N
Second Line :
City : SYRACUSE
State : NE
Zip : 68446-0518
Country : US
Telephone Number : 402-269-2611
Fax Number :
Provider Business Practice Location Address
First Line : 2731 HEALTHCARE DR
Second Line :
City : SYRACUSE
State : NE
Zip : 68446-7880
Country : US
Telephone Number : 402-269-2611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2008
Last Update Date : 09/02/2022

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Directions to “ DANA STARK PA” Practice Location

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