1376655266 NPI number — DR. STEPHEN A MYERS DO

Table of content: DR. STEPHEN A MYERS DO (NPI 1376655266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376655266 NPI number — DR. STEPHEN A MYERS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
STEPHEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1376655266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 METROHEALTH DRIVE
Provider Second Line Business Mailing Address:
METROHEALTH SYSTEM / DEPT OF OB/GYN
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44109-1998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-778-5498
Provider Business Mailing Address Fax Number:
216-778-8847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 METROHEALTH DRIVE
Provider Second Line Business Practice Location Address:
METROHEALTH SYSTEM / DEPT OF OB/GYN
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44109-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-778-5498
Provider Business Practice Location Address Fax Number:
216-778-8847
Provider Enumeration Date:
08/31/2006

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: 207V00000X , with the licence number:  05-28655 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 05-28655 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 34008903 , 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: 26637011 . This is a "BCBS KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 245025408 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 673800 . This is a "FIRSTGUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100359940A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160049230 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2691743 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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