Provider Demographics
NPI:1114172079
Name:DEANE A STITES MD INC
Entity Type:Organization
Organization Name:DEANE A STITES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-587-7461
Mailing Address - Street 1:10051 LAKE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0445
Mailing Address - Country:US
Mailing Address - Phone:530-587-7461
Mailing Address - Fax:530-587-1149
Practice Address - Street 1:10051 LAKE AVE
Practice Address - Street 2:STE 3
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0445
Practice Address - Country:US
Practice Address - Phone:530-587-7461
Practice Address - Fax:530-587-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31474207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200018214OtherRAILROAD MEDICARE
CA00G374740Medicaid
CA00G314740Medicare PIN
CAA44783Medicare UPIN
CA0822420001Medicare NSC