=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487816898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT TEAYS PODIATRY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2008
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 TEAYS VALLEY RD STE A
-----------------------------------------------------
City | HURRICANE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25526-9645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-201-1240
-----------------------------------------------------
Fax | 606-324-0059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3701 TEAYS VALLEY RD STE A
-----------------------------------------------------
City | HURRICANE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25526-9645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-201-1240
-----------------------------------------------------
Fax | 606-324-0059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SETRH STINEHOUR
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 304-201-1240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 00332
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------