Provider Demographics
NPI:1801644950
Name:MODOCK, STEVE JR
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:MODOCK
Suffix:JR
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 1:58555 N STAR RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9424
Mailing Address - Country:US
Mailing Address - Phone:740-260-4974
Mailing Address - Fax:
Practice Address - Street 1:58555 N STAR RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9424
Practice Address - Country:US
Practice Address - Phone:740-260-4974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant