1144208745 NPI number — DR. THERESA TUCKER STEELE PHD

Table of content: DR. THERESA TUCKER STEELE PHD (NPI 1144208745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144208745 NPI number — DR. THERESA TUCKER STEELE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEELE
Provider First Name:
THERESA
Provider Middle Name:
TUCKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
THERESA
Provider Other Middle Name:
LYLA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144208745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 HARMON AVE, STE. 1D03
Provider Second Line Business Mailing Address:
WINN ARMY COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314-5674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-767-7301
Provider Business Mailing Address Fax Number:
912-767-7303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 HARMON AVE, STE. 1D03
Provider Second Line Business Practice Location Address:
WINN ARMY COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-5674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-767-7301
Provider Business Practice Location Address Fax Number:
912-767-7303
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2798 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 2798 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0454U . This is a "BCBS PRIVATE PRACTICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: D6944 . This is a "MEDCOST PRIVATE PRACTICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 046RU . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6000461 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000699 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com