MEDICARE: JOHN C STEVENS

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1679938302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C STEVENS

Provider Business Mailing Address
First Line	:	3025 S MERIDIAN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80929-9712
Country	:	US
Telephone Number	:	719-660-1569
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 S MERIDIAN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80929-9712
Country	:	US
Telephone Number	:	719-660-1569
Fax Number	:

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

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/23/2015

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Directions to “ JOHN C STEVENS ” Practice Location

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