Provider Demographics
NPI:1558322420
Name:STEBBINS, THOMAS R (PAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:STEBBINS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1281
Mailing Address - Street 2:CO GOOD SAMARITAN HOSPITAL
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-270-7740
Mailing Address - Fax:717-270-3877
Practice Address - Street 1:4TH & WALNUT STREETS
Practice Address - Street 2:GOOD SAMARITAN HOSPITAL
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-1281
Practice Address - Country:US
Practice Address - Phone:717-270-7740
Practice Address - Fax:717-270-3877
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001330L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03246501OtherCAPITAL BLUE CROSS
PA120983KAGMedicare PIN
PA03246501OtherCAPITAL BLUE CROSS
S36726Medicare UPIN