Provider Demographics
NPI:1336318856
Name:JOHN STEVENSON INC
Entity Type:Organization
Organization Name:JOHN STEVENSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REGIS
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-264-3150
Mailing Address - Street 1:8721 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1331
Mailing Address - Country:US
Mailing Address - Phone:937-264-3150
Mailing Address - Fax:937-264-3171
Practice Address - Street 1:8721 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1331
Practice Address - Country:US
Practice Address - Phone:937-264-3150
Practice Address - Fax:937-264-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2629301Medicaid
OH2629301Medicaid
OH4456490001Medicare NSC
OH9284171Medicare PIN