1235218264 NPI number — DR. STEVEN A STEPHENS PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235218264 NPI number — DR. STEVEN A STEPHENS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENS
Provider First Name:
STEVEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1235218264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2949
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLDOTNA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99669-2949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-260-7303
Provider Business Mailing Address Fax Number:
907-260-7301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 EAST MARYDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-260-3691
Provider Business Practice Location Address Fax Number:
907-260-7301
Provider Enumeration Date:
11/02/2006

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: 103T00000X , with the licence number:  202074 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200490232 . This is a "AETNA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 200490232 . This is a "TRICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 200490232 . This is a "MAGELLAN B H" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 200490232 . This is a "SMITH ADMIN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: FH177FQ , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010145726 . This is a "BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 200490232 . This is a "CCN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 200490232 . This is a "BANKERS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 806767800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: MH0156 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200490232 . This is a "BPA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE CROSS . This is a "N5749" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "200490232" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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