Provider Demographics
NPI:1477621340
Name:STEPHEN R. PARDEN, LLC
Entity Type:Organization
Organization Name:STEPHEN R. PARDEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:PARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-751-1461
Mailing Address - Street 1:119 HIGH PINES RDG
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6373
Mailing Address - Country:US
Mailing Address - Phone:251-751-1461
Mailing Address - Fax:
Practice Address - Street 1:119 HIGH PINES RDG
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-6373
Practice Address - Country:US
Practice Address - Phone:251-751-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0013491261QA1903X
NH12985282N00000X, 282NR1301X
ME017342282N00000X, 282NR1301X
AK6533282N00000X, 282NR1301X
MS20888282N00000X
AL00013491282N00000X, 282NC0060X, 282NR1301X
ORMD27134282NC0060X
WI50462-20282NC0060X
NE25254282NC0060X
WAMD00047412282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000082985Medicaid
NH30206244Medicaid
AL05263Medicare ID - Type Unspecified