1063539997 NPI number — JEFFERSON BEHAVIORAL HEALTH SYSTEM

Table of content: MARY ELIZABETH STABEN MD (NPI 1770593626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063539997 NPI number — JEFFERSON BEHAVIORAL HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON BEHAVIORAL HEALTH SYSTEM
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:
1063539997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ROSS PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-264-7751
Provider Business Mailing Address Fax Number:
740-264-2422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ROSS PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
STEUBENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43952-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-264-7751
Provider Business Practice Location Address Fax Number:
740-264-2422
Provider Enumeration Date:
03/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPOSH
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
740-264-7751

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  0191 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1308 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1310 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2488455 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7063 . This is a "MACSIS LEGACY PROVIDER ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0200517 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24-01 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2410733 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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