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General NPI Number Information
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NPI Number | 1417109489
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Entity Type | Organization
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Legal Business Name | GREAT TEAYS PODIATRY
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 3701 TEAYS VALLEY ROAD SUITE A
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-201-1240
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Fax | 304-201-1241
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Provider Business Mailing Address
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Address Line | 3701 TEAYS VALLEY ROAD SUITE A
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City | HURRICANE
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State | WV
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Zip | 25526-9645
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Country | US
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Telephone | 304-201-1240
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Fax | 304-201-1241
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Authorized Official
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Title or Position | OWNER
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Name | DR. SETH J STINEHOUR
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Credential | DPM
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Telephone | 304-201-1240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 10383
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License Number State | WV
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