Basic Information
| Provider Information | |||||||||
| NPI: | 1588748099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEVEN M BERNSTEIN, MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1129 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708742470 | ||||||||
| FaxNumber: | 9708742475 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 PARKSIDE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809103131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194717226 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | BERNSTEIN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9708742470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 37776 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | BEBE1788 | 01 | CO | BCBS - GROUP | OTHER | 19131763 | 05 | CO | MEDICAID |