Provider Demographics
NPI:1083887848
Name:SHERIDAN S. H .STEVENS M.D., FACS, PC
Entity Type:Organization
Organization Name:SHERIDAN S. H .STEVENS M.D., FACS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:S H
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-554-6500
Mailing Address - Street 1:3600 NE RALPH POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 NE RALPH POWELL RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2369
Practice Address - Country:US
Practice Address - Phone:816-554-6500
Practice Address - Fax:816-554-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107199208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13-00057OtherUNITED HEALTHCARE
MO21480019OtherBLUE CROSS BLUE SHIELD
MO5818033OtherAETNA
MO7303198OtherCIGNA
MO33802OtherHEALTH CARE USA
MO7013OtherCOVENTRY
MO0007512Medicare UPIN