Provider Demographics
NPI:1568794477
Name:STEVEN D ATWOOD, MD FACP
Entity Type:Organization
Organization Name:STEVEN D ATWOOD, MD FACP
Other - Org Name:STEVEN D ATWOOD MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-269-9200
Mailing Address - Street 1:3525 S NATIONAL AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7310
Mailing Address - Country:US
Mailing Address - Phone:417-269-9200
Mailing Address - Fax:417-269-9204
Practice Address - Street 1:3525 S NATIONAL AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7310
Practice Address - Country:US
Practice Address - Phone:417-269-9200
Practice Address - Fax:417-269-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1K19207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202763057Medicaid
MO202763057Medicaid