MEDICARE: SHERIDAN S. H .STEVENS M.D., FACS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	107199	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13-00057	OTHER	MO	UNITED HEALTHCARE
2	21480019	OTHER	MO	BLUE CROSS BLUE SHIELD
3	5818033	OTHER	MO	AETNA
4	7303198	OTHER	MO	CIGNA
5	33802	OTHER	MO	HEALTH CARE USA
6	7013	OTHER	MO	COVENTRY

General Provider Information

NPI Number	:	1083887848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN S. H .STEVENS M.D., FACS, PC

Provider Business Mailing Address
First Line	:	3600 NE RALPH POWELL RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 NE RALPH POWELL RD
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2369
Country	:	US
Telephone Number	:	816-554-6500
Fax Number	:	816-554-6503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHERIDAN S. H. STEVENS
Credential	:	M.D.
Telephone Number	:	816-554-6500

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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