Provider Demographics
NPI:1417109489
Name:GREAT TEAYS PODIATRY
Entity Type:Organization
Organization Name:GREAT TEAYS PODIATRY
Other - Org Name:SETH J STINEHOUR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:STINEHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-201-1240
Mailing Address - Street 1:3701 TEAYS VALLEY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9645
Mailing Address - Country:US
Mailing Address - Phone:304-201-1240
Mailing Address - Fax:304-201-1241
Practice Address - Street 1:3701 TEAYS VALLEY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9645
Practice Address - Country:US
Practice Address - Phone:304-201-1240
Practice Address - Fax:304-201-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10383213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty