Basic Information
Provider Information | |||||||||
NPI: | 1780650853 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FERGUSON | ||||||||
FirstName: | STEVEN | ||||||||
MiddleName: | W | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 717 STATE STREET | ||||||||
Address2: | SUITE 16 LL, REGIONAL HEALTH SERVICES INC | ||||||||
City: | ERIE | ||||||||
State: | PA | ||||||||
PostalCode: | 165011360 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8148777100 | ||||||||
FaxNumber: | 8144807604 | ||||||||
Practice Location | |||||||||
Address1: | 201 STATE STREET | ||||||||
Address2: | HAMOT FACULTY SPECIALISTS | ||||||||
City: | ERIE | ||||||||
State: | PA | ||||||||
PostalCode: | 165500002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8148774922 | ||||||||
FaxNumber: | 8148773622 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/27/2006 | ||||||||
LastUpdateDate: | 10/09/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS007021L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 001298330002 | 05 | PA |   | MEDICAID | 0012983330005 | 05 | PA |   | MEDICAID |