Healthcare Provider Details

I. General information

NPI: 1871004606
Provider Name (Legal Business Name): STEVEN PINGSTON AT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 ROLLING RIDGE LN
HOLT MI
48842-8721
US

IV. Provider business mailing address

2347 ROLLING RIDGE LN
HOLT MI
48842-8721
US

V. Phone/Fax

Practice location:
  • Phone: 517-242-1361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000262
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: