Provider Demographics
NPI:1508642604
Name:KEVIN D. STEFFEN JR. DPM, PA
Entity Type:Organization
Organization Name:KEVIN D. STEFFEN JR. DPM, PA
Other - Org Name:MOUNTAIN HOME PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:870-580-5589
Mailing Address - Street 1:509 STEFFEN HILL LN
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72661-8017
Mailing Address - Country:US
Mailing Address - Phone:870-580-5589
Mailing Address - Fax:
Practice Address - Street 1:806 WEST RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4510
Practice Address - Country:US
Practice Address - Phone:724-944-2573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies