Provider Demographics
NPI:1164767539
Name:BENJAMIN S STEHOWER
Entity Type:Organization
Organization Name:BENJAMIN S STEHOWER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-533-5253
Mailing Address - Street 1:805 WHIPPLE ST
Mailing Address - Street 2:STE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1617
Mailing Address - Country:US
Mailing Address - Phone:928-533-5253
Mailing Address - Fax:928-777-9183
Practice Address - Street 1:805 WHIPPLE ST
Practice Address - Street 2:STE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1617
Practice Address - Country:US
Practice Address - Phone:928-533-5253
Practice Address - Fax:928-777-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ451060335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier