MEDICARE: STEPHEN PINSK, M.D., INC.

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	291U00000X	Clinical Medical Laboratory	CLF3829	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295888790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN PINSK, M.D., INC.

Provider Business Mailing Address
First Line	:	PO BOX 1676
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95473-1676
Country	:	US
Telephone Number	:	707-829-5883
Fax Number	:	707-829-5895

Provider Business Practice Location Address
First Line	:	5176 HILL RD E
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-6300
Country	:	US
Telephone Number	:	707-829-5883
Fax Number	:	707-829-5895

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVE C. MERTENS
Credential	:	M.D.
Telephone Number	:	707-829-5883

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	10/03/2007

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