Provider Demographics
NPI:1912057134
Name:STEPHEN F LOVICH LLC
Entity Type:Organization
Organization Name:STEPHEN F LOVICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-512-4771
Mailing Address - Street 1:280 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6649
Mailing Address - Country:US
Mailing Address - Phone:541-512-4771
Mailing Address - Fax:541-512-0880
Practice Address - Street 1:280 S PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6649
Practice Address - Country:US
Practice Address - Phone:541-512-4771
Practice Address - Fax:541-512-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24794208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232889Medicaid
OR232889Medicaid