Provider Demographics
NPI:1639353949
Name:WILLIAM M STINSON MD MEDICAL CORP
Entity Type:Organization
Organization Name:WILLIAM M STINSON MD MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-646-8479
Mailing Address - Street 1:2101 JACKSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4386
Mailing Address - Country:US
Mailing Address - Phone:765-646-8479
Mailing Address - Fax:765-646-8526
Practice Address - Street 1:2101 JACKSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4386
Practice Address - Country:US
Practice Address - Phone:765-646-8479
Practice Address - Fax:765-646-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000100998OtherANTHEM BLUE CROSS
IN000000100998OtherANTHEM BLUE CROSS