Provider Demographics
NPI:1669619599
Name:STEESE ORTHOPAEDIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:STEESE ORTHOPAEDIC ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:COBDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-374-4636
Mailing Address - Street 1:PO BOX 70346
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0346
Mailing Address - Country:US
Mailing Address - Phone:907-374-4636
Mailing Address - Fax:907-458-4896
Practice Address - Street 1:1405 KELLUM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4102
Practice Address - Country:US
Practice Address - Phone:907-374-4636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3275207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG028Medicaid
AK6329470002Medicare NSC
AKK162199Medicare PIN