1437398112 NPI number — STEVEN P. MEDEIROS, D.O., INC.

Table of content: (NPI 1437398112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437398112 NPI number — STEVEN P. MEDEIROS, D.O., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN P. MEDEIROS, D.O., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437398112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTEAU
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74953-1278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-635-3578
Provider Business Mailing Address Fax Number:
918-635-3479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SMITH AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
POTEAU
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74953-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-647-0670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MEDEIROS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-635-3578

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2800 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 2800 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com