Basic Information
| Provider Information | |||||||||
| NPI: | 1417103813 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEVEN L FIELDS MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4777 US HIGHWAY 259 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756057668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036634800 | ||||||||
| FaxNumber: | 9036630378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 HIGHWAY 34 S | ||||||||
| Address2: | RENAISSANCE HOSPITAL RADIOLOGY DEPARTMENT | ||||||||
| City: | TERRELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751604833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725637611 | ||||||||
| FaxNumber: | 9725516808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | PITTMON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9036634800 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEVEN L FIELDS MD PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | J4109 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 188860401 | 05 | TX | MEDICAID |