Provider Demographics
NPI:1629392253
Name:DENICE STARLEY, D.O.,P.C.
Entity Type:Organization
Organization Name:DENICE STARLEY, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:STARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-622-7983
Mailing Address - Street 1:PO BOX 778436
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8436
Mailing Address - Country:US
Mailing Address - Phone:702-622-7983
Mailing Address - Fax:702-614-8047
Practice Address - Street 1:7670 W SAHARA AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2751
Practice Address - Country:US
Practice Address - Phone:702-212-3333
Practice Address - Fax:702-212-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1334208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104760OtherMEDICARE
NVPART B # 104760Medicaid