Provider Demographics
NPI:1487675203
Name:RANDY RAY STEVENS
Entity Type:Organization
Organization Name:RANDY RAY STEVENS
Other - Org Name:RANDY STEVENS FAMILY FOOTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-561-1453
Mailing Address - Street 1:845 SIR THOMAS CT STE D
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4840
Mailing Address - Country:US
Mailing Address - Phone:717-561-1453
Mailing Address - Fax:
Practice Address - Street 1:845 SIR THOMAS CT STE D
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4840
Practice Address - Country:US
Practice Address - Phone:717-561-1453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007524777OtherAETNA
PA419111OtherHEALTHASSURANCE
PA20050085OtherAMERIHEALTH
PA1814385OtherBCBS OF PA
PA20050085OtherAMERIHEALTH
PA=========OtherTAX ID NUMBER