Provider Demographics
NPI:1154662849
Name:SEAN L STEWARD, MD, PC
Entity Type:Organization
Organization Name:SEAN L STEWARD, MD, PC
Other - Org Name:GENEVA HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GORMAN-STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:503-992-0288
Mailing Address - Street 1:3838 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2224
Mailing Address - Country:US
Mailing Address - Phone:503-992-0288
Mailing Address - Fax:503-359-4724
Practice Address - Street 1:3838 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2224
Practice Address - Country:US
Practice Address - Phone:503-992-0288
Practice Address - Fax:503-359-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR260204-95261QP2300X
OR12202-001261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR085204Medicaid
OR085204Medicaid
OR121249Medicare PIN