Healthcare Provider Details

I. General information

NPI: 1124471024
Provider Name (Legal Business Name): A C STEVENS ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 JADLOS DR
FINDLAY OH
45840-1683
US

IV. Provider business mailing address

9660 JADLOS DR
FINDLAY OH
45840-1683
US

V. Phone/Fax

Practice location:
  • Phone: 419-420-9395
  • Fax:
Mailing address:
  • Phone: 419-420-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW B STEVENS
Title or Position: OWNER
Credential:
Phone: 419-420-9395