=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841389426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHEN MARK OLMSTEAD, D.O., ALLERGY, ASTHMA & IMMUNOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7150 N PRESIDENT GEORGE BUSH HWY SUITE 204
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75044-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-463-3406
-----------------------------------------------------
Fax | 972-412-6317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7150 N PRESIDENT GEORGE BUSH HWY SUITE 204
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75044-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-463-3406
-----------------------------------------------------
Fax | 972-412-6317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEPHEN MARK OLMSTEAD
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 972-463-3406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | J8336
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------