Provider Demographics
NPI:1275589731
Name:KEITH D. STARKWEATHER, MD, PC
Entity Type:Organization
Organization Name:KEITH D. STARKWEATHER, MD, PC
Other - Org Name:DBA THE BONE & JOINT GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-905-1001
Mailing Address - Street 1:980 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5251
Mailing Address - Country:US
Mailing Address - Phone:931-905-1001
Mailing Address - Fax:931-905-0410
Practice Address - Street 1:980 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5251
Practice Address - Country:US
Practice Address - Phone:931-905-1001
Practice Address - Fax:931-905-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720366Medicaid
TNCG8067OtherRAILROAD MEDICARE
TN3720366Medicaid