1548457203 NPI number — STEPHEN E. HATFIELD, DO LLC

Table of content: (NPI 1548457203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548457203 NPI number — STEPHEN E. HATFIELD, DO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN E. HATFIELD, DO 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:
Provider Other Organization Name Type Code:
6
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:
1548457203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4850 E. BASELINE ROAD
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-461-0047
Provider Business Mailing Address Fax Number:
480-461-1103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4850 E. BASELINE ROAD
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-461-0047
Provider Business Practice Location Address Fax Number:
480-461-1103
Provider Enumeration Date:
09/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HATFIELD
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
480-461-0047

Provider Taxonomy Codes

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

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

  • Identifier: 312231 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com