Provider Demographics
NPI:1902893282
Name:STEVEN B SPARKS DO LTD LLC
Entity Type:Organization
Organization Name:STEVEN B SPARKS DO LTD LLC
Other - Org Name:STEVEN B SPARKS DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-626-5252
Mailing Address - Street 1:1723 COLUMBUS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3546
Mailing Address - Country:US
Mailing Address - Phone:419-626-5252
Mailing Address - Fax:419-626-5335
Practice Address - Street 1:1723 COLUMBUS AVE
Practice Address - Street 2:STE D
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3546
Practice Address - Country:US
Practice Address - Phone:419-626-5252
Practice Address - Fax:419-626-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000258764OtherANTHEM BLUE CROSS
OH000000258764OtherANTHEM BLUE CROSS