Provider Demographics
NPI:1205994654
Name:STEVENS SURGICAL SUPPLY, INC
Entity type:Organization
Organization Name:STEVENS SURGICAL SUPPLY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-846-5740
Mailing Address - Street 1:771 DEARBORN PARK LN
Mailing Address - Street 2:SUITE Q
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5720
Mailing Address - Country:US
Mailing Address - Phone:614-846-5740
Mailing Address - Fax:614-846-5745
Practice Address - Street 1:771 DEARBORN PARK LN
Practice Address - Street 2:SUITE Q
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-5720
Practice Address - Country:US
Practice Address - Phone:614-846-5740
Practice Address - Fax:614-846-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL11213332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232617Medicaid
OH0232617Medicaid