Provider Demographics
NPI:1285685602
Name:PRESTON, STEVEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1559
Mailing Address - Country:US
Mailing Address - Phone:270-358-3829
Mailing Address - Fax:270-358-9350
Practice Address - Street 1:207 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1559
Practice Address - Country:US
Practice Address - Phone:270-358-3829
Practice Address - Fax:270-358-9350
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64060908Medicaid
KYP00213887OtherMEDICARE RAILROAD
KY000000270737OtherBC/BS PIN
KYP00213887OtherMEDICARE RAILROAD
KY64060908Medicaid
KY2442561000OtherPASSPORT ADVANTAGE
KY64060908Medicaid