MEDICARE: SCOTT P STEVENS M.D.

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	208600000X	Surgery Physician	01055751	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000705025	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821093758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT P STEVENS M.D.

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-962-6053
Fax Number	:	765-935-7401

Provider Business Practice Location Address
First Line	:	1050 REID PKWY STE 120
Second Line	:	GENERAL SURGEONS
City	:	RICHMOND
State	:	IN
Zip	:	47374-1156
Country	:	US
Telephone Number	:	765-962-6053
Fax Number	:	765-935-7401

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/18/2021

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Directions to “ SCOTT P STEVENS M.D.” Practice Location

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