MEDICARE: STEIN ANCILLARY SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900522569	OTHER		MEDICARE

General Provider Information

NPI Number	:	1538352695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEIN ANCILLARY SERVICES, LLC

Provider Business Mailing Address
First Line	:	8520 S 36TH TER
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8880
Country	:	US
Telephone Number	:	479-410-1740
Fax Number	:	479-410-1596

Provider Business Practice Location Address
First Line	:	8520 S 36TH TER
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8880
Country	:	US
Telephone Number	:	479-410-1740
Fax Number	:	479-410-1596

Authorized Official
Title or Position	:	CEO
Name	:	MR. PAUL STEIN
Credential	:
Telephone Number	:	228-875-5447

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/03/2009

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Directions to “STEIN ANCILLARY SERVICES, LLC ” Practice Location

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