MEDICARE: DR. STEPHEN SINCLAIR OUTTEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	68928	GA
2	207P00000X	Emergency Medicine Physician	000653	SC
3	207P00000X	Emergency Medicine Physician	2070	TN
4	207P00000X	Emergency Medicine Physician	C2999	KY
5	207P00000X	Emergency Medicine Physician	N7855	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710957832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN SINCLAIR OUTTEN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 1306
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29116-1306
Country	:	US
Telephone Number	:	803-536-2555
Fax Number	:	803-536-0998

Provider Business Practice Location Address
First Line	:	440 HOPKINSVILLE ST
Second Line	:
City	:	GREENVILLE
State	:	KY
Zip	:	42345-1124
Country	:	US
Telephone Number	:	270-338-8000
Fax Number	:	270-338-8333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	02/03/2025

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Directions to “ DR. STEPHEN SINCLAIR OUTTEN D.O.” Practice Location

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