1518940964 NPI number — DR. STEPHEN A TRAMILL DO

Table of content: DR. STEPHEN A TRAMILL DO (NPI 1518940964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518940964 NPI number — DR. STEPHEN A TRAMILL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAMILL
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:
1518940964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 INDIAN CREEK DR
Provider Second Line Business Mailing Address:
P. O. BOX 928
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39345-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-683-6342
Provider Business Mailing Address Fax Number:
601-683-7948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1451 N LAKELAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39307-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-581-8457
Provider Business Practice Location Address Fax Number:
601-581-8464
Provider Enumeration Date:
11/21/2005

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: 207Q00000X , with the licence number:  12207 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00120122 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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