Organization Active NPI

Virginia Stark-Vance, M.D., P.a.

  • Hematology & Oncology Physician
  • Fort Worth, TX
National Provider Identifier
1952539348
Registry record updated Aug 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
J9819 Issued in TX
Legal business name
VIRGINIA STARK-VANCE, M.D., P.A.
Practice address
1325 Pennsylvania Ave
Suite 120
Fort Worth, TX 76104-2158
Phone
(817) 926-2555
Fax
(817) 926-2519
NPI assigned
Jun 24, 2009
Last updated
Aug 27, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Virginia Stark-Vance, M.D.NPI 1861443483
Title
Owner
Phone
(817) 926-2555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0003X J9819 TX Primary

Addresses

Primary practice location

1325 Pennsylvania Ave
Suite 120
Fort Worth, TX 76104-2158

Mailing address

1325 Pennsylvania Ave
Suite 120
Fort Worth, TX 76104-2158
Phone (817) 926-2555

Other identifiers 1

IdentifierTypeStateIssuer
900003253OtherTXRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090626000243 TX Part B Supplier - Clinic/Group Practice 6103977400 Receives reassigned benefits from 1 practitioner
Practice locations: Dallas, TX; Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

7777 Forest Ln
Ste C648
Dallas, TX 75230
Phone (972) 566-2500

1325 Pennsylvania Ave
Ste 120
Fort Worth, TX 76104
Phone (817) 926-2555

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251331200000",
    "number": "1952539348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 PENNSYLVANIA AVE",
            "address_2": "SUITE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042158",
            "telephone_number": "817-926-2555",
            "fax_number": "817-926-2519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 PENNSYLVANIA AVE",
            "address_2": "SUITE 120",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042158",
            "telephone_number": "817-926-2555",
            "fax_number": "817-926-2519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA STARK-VANCE, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-24",
        "last_updated": "2009-08-27",
        "status": "A",
        "authorized_official_last_name": "STARK-VANCE",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-926-2555",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "TX",
            "license": "J9819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "900003253",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.