Provider Demographics
NPI:1437398112
Name:STEVEN P. MEDEIROS, D.O., INC.
Entity Type:Organization
Organization Name:STEVEN P. MEDEIROS, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MEDEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-635-3578
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1278
Mailing Address - Country:US
Mailing Address - Phone:918-635-3578
Mailing Address - Fax:918-635-3479
Practice Address - Street 1:101 SMITH AVE
Practice Address - Street 2:STE 2
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2613
Practice Address - Country:US
Practice Address - Phone:918-647-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2800207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100740880AMedicaid