Provider Demographics
NPI:1730388984
Name:MARY BETH STABEN MD LLC
Entity type:Organization
Organization Name:MARY BETH STABEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:STABEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-277-8179
Mailing Address - Street 1:125 CHINOE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1959
Mailing Address - Country:US
Mailing Address - Phone:859-277-8179
Mailing Address - Fax:859-277-9320
Practice Address - Street 1:125 CHINOE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1959
Practice Address - Country:US
Practice Address - Phone:859-277-8179
Practice Address - Fax:859-277-9320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH24946Medicare UPIN