1194902189 NPI number — REBECCA R. STEVES, DMD, PC

Table of content: (NPI 1194902189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194902189 NPI number — REBECCA R. STEVES, DMD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBECCA R. STEVES, DMD, 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:
6
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:
1194902189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
983 N CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORRY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16407-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-664-4011
Provider Business Mailing Address Fax Number:
814-664-9376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
983 N CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORRY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16407-1228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-664-4011
Provider Business Practice Location Address Fax Number:
814-664-9376
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNST
Authorized Official First Name:
AUTUMN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS COORDINATOR
Authorized Official Telephone Number:
814-664-4011

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DSO19110L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DSO38747 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1015262710001 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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