1861478968 NPI number — SHANE D STENEHJEM

Table of content: SHANE D STENEHJEM (NPI 1861478968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861478968 NPI number — SHANE D STENEHJEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENEHJEM
Provider First Name:
SHANE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1861478968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 SUMMER STREET
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02038-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-528-2525
Provider Business Mailing Address Fax Number:
508-520-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 SUMMER STREET
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02038-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-528-2525
Provider Business Practice Location Address Fax Number:
508-520-8901
Provider Enumeration Date:
12/20/2005

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: 213E00000X , with the licence number:  2204 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y71124 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 494209 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA43714 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 27-01097 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7429718 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com