1669619599 NPI number — STEESE ORTHOPAEDIC ASSOCIATES, LLC

Table of content: (NPI 1669619599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669619599 NPI number — STEESE ORTHOPAEDIC ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEESE ORTHOPAEDIC ASSOCIATES, LLC
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:
FAIRBANKS ORTHOPAEDIC CENTER
Provider Other Organization Name Type Code:
3
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:
1669619599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99707-0346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-374-4636
Provider Business Mailing Address Fax Number:
907-458-4896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 KELLUM ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-374-4636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COBDEN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
907-374-4636

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  3275 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MDG028 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com