Provider Demographics
NPI:1417103813
Name:STEVEN L FIELDS MD PA
Entity Type:Organization
Organization Name:STEVEN L FIELDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-663-4800
Mailing Address - Street 1:4777 US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7668
Mailing Address - Country:US
Mailing Address - Phone:903-663-4800
Mailing Address - Fax:903-663-0378
Practice Address - Street 1:1551 HIGHWAY 34 S
Practice Address - Street 2:RENAISSANCE HOSPITAL RADIOLOGY DEPARTMENT
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4833
Practice Address - Country:US
Practice Address - Phone:972-563-7611
Practice Address - Fax:972-551-6808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN L FIELDS MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ41092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188860401Medicaid
TX00Y180Medicare PIN