Healthcare Provider Details

I. General information

NPI: 1164767539
Provider Name (Legal Business Name): BENJAMIN S STEHOWER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WHIPPLE ST STE A
PRESCOTT AZ
86301-1617
US

IV. Provider business mailing address

805 WHIPPLE ST STE A
PRESCOTT AZ
86301-1617
US

V. Phone/Fax

Practice location:
  • Phone: 928-533-5253
  • Fax: 928-777-9183
Mailing address:
  • Phone: 928-533-5253
  • Fax: 928-777-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number451060
License Number StateAZ

VIII. Authorized Official

Name: BENJAMIN S STEHOWER
Title or Position: OWNER
Credential:
Phone: 928-533-5253