Active NPI
Stanley Michael Hicks, M.D.
- Diagnostic Radiology Physician
- Kelso, WA
National Provider Identifier
1336129451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- MD00029538
- Practice address
- 700 Lincoln St
Suite 100
Kelso, WA 98626-1057 - Phone
- (360) 425-5131
- NPI assigned
- Jan 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD00029538 | WA | Primary |
Addresses
Primary practice location
700 Lincoln St
Suite 100
Kelso, WA 98626-1057
Mailing address
700 Lincoln St
Suite 100
Kelso, WA 98626-1057
Phone (360) 425-5131
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8136988 | Medicaid | WA | |
| 040803 | Other | OR | OREGON DSHS |
| 34871 | Other | WA | LABOR & INDUSTRIES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1336129451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 LINCOLN ST",
"address_2": "SUITE 100",
"city": "KELSO",
"state": "WA",
"postal_code": "986261057",
"telephone_number": "360-425-5131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 LINCOLN ST",
"address_2": "SUITE 100",
"city": "KELSO",
"state": "WA",
"postal_code": "986261057",
"telephone_number": "360-425-5131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "STANLEY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-17",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "WA",
"license": "MD00029538",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8136988",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON DSHS",
"identifier": "040803",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "34871",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kelso, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.