Provider Demographics
NPI:1255504320
Name:STEPHEN THOMAS SCHIFFGEN
Entity type:Organization
Organization Name:STEPHEN THOMAS SCHIFFGEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCHIFFGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-501-4335
Mailing Address - Street 1:9690 S 1300 E
Mailing Address - Street 2:#120
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3721
Mailing Address - Country:US
Mailing Address - Phone:801-501-4335
Mailing Address - Fax:801-501-4338
Practice Address - Street 1:9690 S 1300 E
Practice Address - Street 2:#120
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3721
Practice Address - Country:US
Practice Address - Phone:801-501-4335
Practice Address - Fax:801-501-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1028650501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1104990001Medicare NSC