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General NPI Number Information
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NPI Number | 1417371279
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Entity Type | Organization
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Legal Business Name | EAST STATE MHT LLC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 506 S 6TH ST
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City | LEESVILLE
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State | LA
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Zip | 71446-4482
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Country | US
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Telephone | 972-616-4702
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 HERITAGE DR SUITE 110
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City | MCKINNEY
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State | TX
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Zip | 75069-3256
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Country | US
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Telephone | 972-616-4702
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID STEINER
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Credential |
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Telephone | 337-392-2330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D6686
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | MD.06170R
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License Number State | LA
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