1053307298 NPI number — DR. STEPHEN PATRICK ANTHONY D.O.

Table of content: RICHARD A GRIMM DO (NPI 1033204623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053307298 NPI number — DR. STEPHEN PATRICK ANTHONY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTHONY
Provider First Name:
STEPHEN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1053307298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 E FARWELL RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-464-2873
Provider Business Practice Location Address Fax Number:
509-466-0914
Provider Enumeration Date:
09/22/2005

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: 207RH0003X , with the licence number:  OP00001601 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8226334 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010143048 . This is a "BLUE SHIELD OF IDAHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805167400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83004753 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 121591 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5337010 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AN7110 . This is a "ASURIS NW HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: KF781 . This is a "BLUE CROSS OF IDAHO" identifier . This identifiers is of the category "OTHER".




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