Provider Demographics
NPI:1285829929
Name:STEVENS MEDICAL CLINIC P.C.
Entity Type:Organization
Organization Name:STEVENS MEDICAL CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1308-728-3154
Mailing Address - Street 1:1820 N ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1623
Mailing Address - Country:US
Mailing Address - Phone:308-728-3154
Mailing Address - Fax:308-728-3274
Practice Address - Street 1:1820 N ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1623
Practice Address - Country:US
Practice Address - Phone:308-728-3154
Practice Address - Fax:308-728-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE32060622500Medicaid
NE=========00Medicaid
NEP47934Medicare UPIN
NE=========00Medicaid
NE32060622500Medicaid