Provider Demographics
NPI:1326130915
Name:STEPHEN R MCINTYRE MD PLLC
Entity Type:Organization
Organization Name:STEPHEN R MCINTYRE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-294-1116
Mailing Address - Street 1:1940 BRIARWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5497
Mailing Address - Country:US
Mailing Address - Phone:828-294-1116
Mailing Address - Fax:828-294-0096
Practice Address - Street 1:1940 BRIARWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5497
Practice Address - Country:US
Practice Address - Phone:828-294-1116
Practice Address - Fax:828-294-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0093-00230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8956809Medicaid
NC56809OtherBCBS OF NORTH CAROLINA
NC8956809Medicaid
NC2340379Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER