1083887848 NPI number — SHERIDAN S. H .STEVENS M.D., FACS, PC

Table of content: (NPI 1083887848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083887848 NPI number — SHERIDAN S. H .STEVENS M.D., FACS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERIDAN S. H .STEVENS M.D., FACS, PC
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:
1083887848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 NE RALPH POWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64064-2369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 NE RALPH POWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64064-2369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-554-6500
Provider Business Practice Location Address Fax Number:
816-554-6503
Provider Enumeration Date:
04/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
SHERIDAN
Authorized Official Middle Name:
S. H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-554-6500

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  107199 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13-00057 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 21480019 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5818033 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7303198 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 33802 . This is a "HEALTH CARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7013 . This is a "COVENTRY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com