MEDICARE: DR. JEREMY SHANE STEVENS M.D.

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	207X00000X	Orthopaedic Surgery Physician	231357	MA
2	207X00000X	Orthopaedic Surgery Physician	036-111903	IL

General Provider Information

NPI Number	:	1306843446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY SHANE STEVENS M.D.

Provider Business Mailing Address
First Line	:	1005 HEALTH CENTER DR STE 201
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-4693
Country	:	US
Telephone Number	:	217-238-6055
Fax Number	:	217-258-2216

Provider Business Practice Location Address
First Line	:	1004 HEALTH CENTER DR STE 100
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-9253
Country	:	US
Telephone Number	:	217-238-3435
Fax Number	:	217-238-3492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/08/2019

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Directions to “ DR. JEREMY SHANE STEVENS M.D.” Practice Location

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