1578650172 NPI number — DR. STEVEN PENA D.C.

Table of content: DR. STEVEN PENA D.C. (NPI 1578650172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578650172 NPI number — DR. STEVEN PENA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENA
Provider First Name:
STEVEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1578650172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALPOLE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03608-0478
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:
40 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALPOLE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03608-0478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-756-9644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

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: 111N00000X , with the licence number:  248-1086 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050272440NH01 . This is a "ANTHEM PROVIDER BILLING #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30003109 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENA0069039 . This is a "BCBSVT PROVIDER BILLING #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 00069039 . This is a "BCBS-VERMONT PROVIDER NUM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0272400 . This is a "ANTHEM PROVIDER #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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