Provider Demographics
NPI:1609109511
Name:ALI STARKES MEDICAL GROUP
Entity Type:Organization
Organization Name:ALI STARKES MEDICAL GROUP
Other - Org Name:SOUTHPORT URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-501-0728
Mailing Address - Street 1:3605 AGNETA COURT
Mailing Address - Street 2:C/O MICALIMAR & ASSOCIATES
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0040
Mailing Address - Country:US
Mailing Address - Phone:916-226-6190
Mailing Address - Fax:916-226-6195
Practice Address - Street 1:2455 JEFFERSON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5313
Practice Address - Country:US
Practice Address - Phone:916-226-6190
Practice Address - Fax:916-226-6195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALI STARKES MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-09
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA369430OtherFNP