Provider Demographics
NPI:1487816898
Name:GREAT TEAYS PODIATRY, PLLC
Entity Type:Organization
Organization Name:GREAT TEAYS PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETRH
Authorized Official - Middle Name:
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 RD STE A
Mailing Address - Street 2:
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:606-324-0059
Practice Address - Street 1:3701 TEAYS VALLEY RD STE A
Practice Address - Street 2:
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:606-324-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3810000605Medicaid
OH2508058Medicaid
WV4134331Medicare PIN
WY3810000605Medicaid