MEDICARE: DR. STEPHEN W. EAKIN M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101042725	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	45207	OTHER	SENTARA/OPTIMA PROVIDER N
2	700010640	OTHER	CIGNA PROVIDER NUMBER
3	186412	OTHER	ANTHEM PROVIDER NUMBER
4	203639329	OTHER	UNITED HEALTHCARE PROVIDE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	203639329	OTHER	PCHP PROVIDER NUMBER
7	203639329013	OTHER	TRICARE PROVIDER NUMBER
8	010215072	OTHER	VA PREMIER
9	329078	OTHER	SOUTHERN HEALTH PROVIDER
10	47475	OTHER	MEDCOST PROVIDER NUMBER

NPI Number	:	1770580128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN W. EAKIN M.D.

Provider Business Mailing Address
First Line	:	1204 FENWICK DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280A MAIN ST
Second Line	:
City	:	ALTAVISTA
State	:	VA
Zip	:	24517-1465
Country	:	US
Telephone Number	:	434-309-1165
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/04/2011

1280A MAIN ST
ALTAVISTA, VA
24517-1465

Practice Phone: 434-369-1165
Practice Fax:

1280A MAIN ST
ALTAVISTA, VA
24517-1465