Basic Information
Provider Information
NPI: 1578056800
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EBERS
FirstName: STEVEN
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1530 N 7TH ST STE 200
Address2:  
City: TERRE HAUTE
State: IN
PostalCode: 478071061
CountryCode: US
TelephoneNumber: 8122387631
FaxNumber: 8122387003
Practice Location
Address1: 108 FRIZZELL ST
Address2:  
City: POTOSI
State: MO
PostalCode: 636641505
CountryCode: US
TelephoneNumber: 5734388500
FaxNumber: 5734388787
Other Information
ProviderEnumerationDate: 06/12/2018
LastUpdateDate: 06/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X11019898AINN Student, Health CareStudent in an Organized Health Care Education/Training Program 
207Q00000X2020023482MOY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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