Provider Demographics
NPI:1871659466
Name:SAMUEL, STEWART & ASSOCIATES, PSC
Entity Type:Organization
Organization Name:SAMUEL, STEWART & ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-583-7741
Mailing Address - Street 1:141 QUARTERMASTER CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3627
Mailing Address - Country:US
Mailing Address - Phone:502-583-7741
Mailing Address - Fax:502-290-9743
Practice Address - Street 1:141 QUARTERMASTER CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3627
Practice Address - Country:US
Practice Address - Phone:502-583-7741
Practice Address - Fax:502-290-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000869923OtherANTHEM
IN300001782Medicaid
KY65906232Medicaid
KY65906232Medicaid
KY1561Medicare PIN