MEDICARE: STEVEN L FIELDS MD PA

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	2085R0202X	Diagnostic Radiology Physician	J4109	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1811108814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN L FIELDS MD PA

Provider Business Mailing Address
First Line	:	4777 US HIGHWAY 259
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-7668
Country	:	US
Telephone Number	:	903-663-4800
Fax Number	:	903-663-0378

Provider Business Practice Location Address
First Line	:	2929 S HAMPTON RD
Second Line	:	RENAISSANCE HOSPITAL - RADIOLOGY DEPARTMENT
City	:	DALLAS
State	:	TX
Zip	:	75224-3026
Country	:	US
Telephone Number	:	214-623-4400
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL PITTMON
Credential	:
Telephone Number	:	903-663-4800

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	03/09/2012

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