1578557849 NPI number — JOHN STEWART PSY.D. PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578557849 NPI number — JOHN STEWART PSY.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN STEWART PSY.D. PC
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:
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:
1578557849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODWARD
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73801-2824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-256-6009
Provider Business Mailing Address Fax Number:
866-895-5991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODWARD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73801-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-256-6009
Provider Business Practice Location Address Fax Number:
866-895-5991
Provider Enumeration Date:
09/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
BENTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
580-256-6009

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  941 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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