1831195825 NPI number — STEVE JUNIOR VANMETER MD

Table of content: STEVE JUNIOR VANMETER MD (NPI 1831195825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831195825 NPI number — STEVE JUNIOR VANMETER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANMETER
Provider First Name:
STEVE
Provider Middle Name:
JUNIOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1831195825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1698 OLD LEBANON RD
Provider Second Line Business Mailing Address:
STE 2B
Provider Business Mailing Address City Name:
CAMPBELLSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42718-9662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-465-3568
Provider Business Mailing Address Fax Number:
270-465-3115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1698 OLD LEBANON RD
Provider Second Line Business Practice Location Address:
STE 2B
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-9662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-3568
Provider Business Practice Location Address Fax Number:
270-465-3115
Provider Enumeration Date:
06/23/2005

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:  28346 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64283468 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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