Provider Demographics
NPI:1326119975
Name:MARIA STEIN FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:MARIA STEIN FAMILY PRACTICE INC
Other - Org Name:SCHWIETERMAN FAMILY PHYSICIANS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-925-4826
Mailing Address - Street 1:8381 STATE ROUTE 119
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-9701
Mailing Address - Country:US
Mailing Address - Phone:419-925-4613
Mailing Address - Fax:419-925-4168
Practice Address - Street 1:8381 STATE ROUTE 119
Practice Address - Street 2:
Practice Address - City:MARIA STEIN
Practice Address - State:OH
Practice Address - Zip Code:45860-9701
Practice Address - Country:US
Practice Address - Phone:419-925-4613
Practice Address - Fax:419-925-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0440991Medicaid
OH=========-00OtherOHIO BUREAU WORKERS COMP
OH0440991Medicaid