Organization
KENNETH STEVENS MD INC A MEDICAL CORPORATION
Active
Other names
Premier Heart Care Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH STEVENS MD (PRESIDENT)
(815) 378-8514
Entity
Organization
Contact information
Practice address
3268 WATERSTONE AVE, HENDERSON, NV 89044-1867
(815) 378-8514
(805) 540-3344
Mailing address
3268 WATERSTONE AVE, HENDERSON, NV 89044-1867
(815) 378-8514
(805) 540-3344
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1083425
CLIA CERTIFICATE OF WAIVER NUMBER
CA
01
—
106286
CITY OF SAN LUIS OBISPO BUSINESS LICENSE
CA
01
—
37534
MEDICAL BOARD FICTITIOUS NAME PERMIT NUMBER
CA
01
—
C3092297
DEPT OF CORPORATIONS NUMBER
CA
01
—
ZZZ53712Y
BLUE SHIELD PROVIDER NUMBER
CA
Enumeration date
04/14/2008
Last updated
05/05/2025
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