Provider Demographics
NPI:1023084985
Name:STEDMAN HEALTH ASSOCIATES INC
Entity type:Organization
Organization Name:STEDMAN HEALTH ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-240-9882
Mailing Address - Street 1:634 PINE RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-1885
Mailing Address - Country:US
Mailing Address - Phone:803-240-9882
Mailing Address - Fax:910-483-0515
Practice Address - Street 1:7445 CLINTON RD
Practice Address - Street 2:
Practice Address - City:STEDMAN
Practice Address - State:NC
Practice Address - Zip Code:28391-8901
Practice Address - Country:US
Practice Address - Phone:910-323-4555
Practice Address - Fax:910-483-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
NC046213336C0003X, 332BD1200X, 332BP3500X, 3336C0003X
04621332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3423097OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC0265652Medicaid
3423097OtherNCPDP PROVIDER IDENTIFICATION NUMBER