Provider Demographics
NPI:1417953050
Name:RICHEY, STEVEN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:THOMAS
Last Name:RICHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 AIRWAYS PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5872
Mailing Address - Country:US
Mailing Address - Phone:662-349-9990
Mailing Address - Fax:662-349-2620
Practice Address - Street 1:122 AIRWAYS PL
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5872
Practice Address - Country:US
Practice Address - Phone:662-349-9990
Practice Address - Fax:662-349-2620
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34251208VP0014X
MS17891208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515129Medicaid
MS02032751Medicaid
F87611Medicare UPIN
MS02032751Medicaid
TN38060166Medicare PIN