Provider Demographics
NPI:1376604363
Name:STEPHEN J. PADEN
Entity Type:Organization
Organization Name:STEPHEN J. PADEN
Other - Org Name:PRAIRIE PSYCHIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-474-1511
Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3796
Mailing Address - Country:US
Mailing Address - Phone:402-474-1511
Mailing Address - Fax:402-474-1517
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-474-1511
Practice Address - Fax:402-474-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid
NE=========26Medicaid