Healthcare Provider Details

I. General information

NPI: 1265978373
Provider Name (Legal Business Name): RICK ANTHONY STEPHENSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 S PROSPECT ST
MARION OH
43302-6225
US

IV. Provider business mailing address

1 WILLOWWOOD DR
CHIPPEWA LAKE OH
44215-9642
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-9293
  • Fax: 740-383-6091
Mailing address:
  • Phone: 440-812-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004952RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: