Provider Demographics
NPI:1205016433
Name:STEPHEN R FEAGINS M.D., LLC
Entity type:Organization
Organization Name:STEPHEN R FEAGINS M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FEAGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-323-1187
Mailing Address - Street 1:247 S BURNETT RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2639
Mailing Address - Country:US
Mailing Address - Phone:937-323-1187
Mailing Address - Fax:937-323-1456
Practice Address - Street 1:247 S BURNETT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2639
Practice Address - Country:US
Practice Address - Phone:937-323-1187
Practice Address - Fax:937-323-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0401897OtherUNITED HEALTHCARE OF OHIO
OH2559361OtherAETNA
OH2233005Medicaid
OH000000195864OtherANTHEM
SP00061Medicare PIN
H33591Medicare UPIN