Provider Demographics
NPI:1003803883
Name:DON R STEPHENS MD PSC
Entity Type:Organization
Organization Name:DON R STEPHENS MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-234-4494
Mailing Address - Street 1:439 E PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031
Mailing Address - Country:US
Mailing Address - Phone:859-234-4494
Mailing Address - Fax:859-234-4483
Practice Address - Street 1:439 E PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031
Practice Address - Country:US
Practice Address - Phone:859-234-4494
Practice Address - Fax:859-234-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64130354Medicaid
KY64130354Medicaid
KY1220201Medicare PIN