Provider Demographics
NPI:1982760658
Name:STEPHEN M TREADWELL
Entity Type:Organization
Organization Name:STEPHEN M TREADWELL
Other - Org Name:STEPHEN TREADWELL, DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-229-0313
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-0276
Mailing Address - Country:US
Mailing Address - Phone:580-229-0313
Mailing Address - Fax:580-229-2045
Practice Address - Street 1:11053 STATE HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438
Practice Address - Country:US
Practice Address - Phone:580-229-0313
Practice Address - Fax:580-229-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4456897818Medicaid
OK4456897818Medicaid