Basic Information
| Provider Information | |||||||||
| NPI: | 1164529061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHARLES E STEINER, DO, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | STEINER FAMILY MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2364 BLIZZARD LN STE A | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457109287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405664720 | ||||||||
| FaxNumber: | 7405664721 | ||||||||
| Practice Location | |||||||||
| Address1: | 2364 BLIZZARD LN STE A | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457109287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405664720 | ||||||||
| FaxNumber: | 7405664721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7405664720 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 34006505S | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207Q00000X | 34006505S | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2181599 | 05 | OH | MEDICAID |