MEDICARE: STEVEN LEE SPALDING MD

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	207Q00000X	Family Medicine Physician	MD24598	TN
2	2084P0800X	Psychiatry Physician	24598	TN
3	2084P0804X	Child & Adolescent Psychiatry Physician	24598	TN
4	207Q00000X	Family Medicine Physician	26761	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080178644	OTHER		RAILROAD MEDICARE
13	P00912399	OTHER	KY	RR MEDICARE PTAN-COMMUNIT MEDICAL ASSOCIATES

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3077229	OTHER	TN	AETNA
2	4025500	OTHER	TN	BLUE CROSS/BLUE SHIELD
4	100029694	OTHER	TN	PHP TENNCARE
5	000057058J	OTHER	KY	HUMANA-CMA
6	01-41818	OTHER	TN	UNITED HEALTH CARE
7	120590	OTHER	KY	SIHO-CMA
8	2522947	OTHER	TN	CIGNA
9	2522947	OTHER	KY	CIGNA-CMA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	50030676	OTHER	KY	PASSPORT-CMA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	000000684412	OTHER	KY	ANTHEM-CMA

General Provider Information

NPI Number	:	1740248806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN LEE SPALDING MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	9342 CEDAR CENTER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4522
Country	:	US
Telephone Number	:	502-239-3228
Fax Number	:	502-231-2517

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/05/2019

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