Provider Demographics
NPI:1033202320
Name:STEVENSON MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:STEVENSON MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-437-2272
Mailing Address - Street 1:196 COUNTY ROAD 85
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-5522
Mailing Address - Country:US
Mailing Address - Phone:256-437-2272
Mailing Address - Fax:256-437-2273
Practice Address - Street 1:196 COUNTY ROAD 85
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-5522
Practice Address - Country:US
Practice Address - Phone:256-437-2272
Practice Address - Fax:256-437-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL013785261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL013785OtherLICENSE#
TN42529OtherLICENSE#
AL009957765Medicaid
TN42529OtherLICENSE#
051521059Medicare ID - Type Unspecified