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NPI Code Detail

MEDICARE: DR. THOMAS WESLEY STIDVENT M.D.

MEDICARE: DR. THOMAS WESLEY STIDVENT 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
12084P0804XChild & Adolescent Psychiatry PhysicianE2879TX

Other Identifiers

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

General Provider Information

NPI Number : 1649361965
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS WESLEY STIDVENT M.D.
Provider Business Mailing Address
First Line : 8216 TEAKWOOD DR
Second Line :
City : WACO
State : TX
Zip : 76712-2426
Country : US
Telephone Number : 254-776-1084
Fax Number :
Provider Business Practice Location Address
First Line : 3501 N 19TH ST
Second Line :
City : WACO
State : TX
Zip : 76708-2007
Country : US
Telephone Number : 254-756-2171
Fax Number : 254-745-5119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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