| Stevenson, Fairchild & Surber Oms, P.c. | |
|
911 Wall St. Suite C Valparaiso IN 46383-2553 | |
| (219) 462-9599 | |
| (219) 464-0369 |
| Full Name | Stevenson, Fairchild & Surber Oms, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 911 Wall St., Valparaiso, Indiana |
| Authorized Official Name and Position | Cheryl Dorris (INSURANCE COORDINATOR) |
| Authorized Official Contact | 2194629599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stevenson, Fairchild & Surber Oms, P.c. 911 Wall St. Suite C Valparaiso IN 46383-2553 Ph: (219) 462-9599 | Stevenson, Fairchild & Surber Oms, P.c. 911 Wall St. Suite C Valparaiso IN 46383-2553 Ph: (219) 462-9599 |
| NPI Number | 1720220015 |
|---|---|
| Provider Enumeration Date | 04/01/2009 |
| Last Update Date | 07/07/2021 |
| Medicare PECOS PAC ID | 9830249317 |
|---|---|
| Medicare Enrollment ID | O20090603000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720220015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Howard E Stevenson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1548351661 PECOS PAC ID: 8820148307 Enrollment ID: I20090615000459 |
| Provider Name | Stephen J Fairchild |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1629164025 PECOS PAC ID: 6901956481 Enrollment ID: I20090616000737 |
| Provider Name | Timothy W Surber |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1144668989 PECOS PAC ID: 4385887371 Enrollment ID: I20171010002035 |
| Provider Name | Ehlie K Bruno |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1417219056 PECOS PAC ID: 4981828761 Enrollment ID: I20210930000222 |
Aspire Oms, Llc Dental Clinic Medicare: Medicare Enrolled Practice Location: 911 Wall St Ste C, Valparaiso, IN 46383 Phone: 219-462-9599 Fax: 219-464-0369 | |
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