Basic Information
Provider Information | |||||||||
NPI: | 1568430130 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ESHENAUR | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 720 | ||||||||
Address2: |   | ||||||||
City: | RIPLEY | ||||||||
State: | WV | ||||||||
PostalCode: | 252710720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3043731517 | ||||||||
FaxNumber: | 3043722749 | ||||||||
Practice Location | |||||||||
Address1: | 122 PINNELL ST | ||||||||
Address2: |   | ||||||||
City: | RIPLEY | ||||||||
State: | WV | ||||||||
PostalCode: | 252719101 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3043731517 | ||||||||
FaxNumber: | 3043722749 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/09/2006 | ||||||||
LastUpdateDate: | 07/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34.007269 | OH | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207Q00000X | 1796 | WV | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 34.007269 | OH | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207P00000X | 1796 | WV | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.