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General NPI Number Information
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NPI Number | 1306843446
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Entity Type | Individual
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Provider Name | JEREMY SHANE STEVENS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 1004 HEALTH CENTER DR STE 100
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City | MATTOON
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State | IL
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Zip | 61938-9253
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Country | US
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Telephone | 217-238-3435
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Fax | 217-238-3492
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Provider Business Mailing Address
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Address Line | 1005 HEALTH CENTER DR STE 201
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City | MATTOON
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State | IL
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Zip | 61938-4693
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Country | US
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Telephone | 217-238-6055
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Fax | 217-258-2216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 231357
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036-111903
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License Number State | IL
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