Healthcare Provider Details

I. General information

NPI: 1396719035
Provider Name (Legal Business Name): STEVEN L ROVENSTINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RAVEN HILL DRIVE
ATCHISON KS
66002
US

IV. Provider business mailing address

800 RAVEN HILL DRIVE
ATCHISON KS
66002
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-2131
  • Fax: 913-674-2023
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-674-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005018834
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0530786
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-30786
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0530786
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: