Individual
STEVEN JOSEPH STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
150 N EAGLE CREEK DR, ST. JOSEPH HOSPITAL EAST, LEXINGTON, KY 40509-1805
(859) 967-5649
Mailing address
PO BOX 633815, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
34619
TN
207P00000X
Emergency Medicine Physician
35076970S
OH
207P00000X
Emergency Medicine Physician
Primary
39966
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000492119
BCBS
KY
05
—
00124499
—
MS
05
—
16108601
—
AR
05
—
3863430
—
TN
01
—
4007244
BCBS
TN
05
—
64131204
—
KY
01
—
P00347535
RAILROAD MEDICARE
KY
Enumeration date
05/30/2006
Last updated
11/19/2007
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