Provider Demographics
NPI:1922141183
Name:HAMMACK, STEVEN JON
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JON
Last Name:HAMMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RURAL ROUTE 1 BOX 109
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107
Mailing Address - Country:US
Mailing Address - Phone:740-974-9349
Mailing Address - Fax:740-569-7260
Practice Address - Street 1:1410 SHERIDAN DR
Practice Address - Street 2:APT 6C
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-689-9326
Practice Address - Fax:740-689-9326
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330687Medicaid