Basic Information
| Provider Information | |||||||||
| NPI: | 1154401065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANECEK | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 E MOCKINGBIRD LANE | ||||||||
| Address2: | #200 | ||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779042194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3165736291 | ||||||||
| FaxNumber: | 3615762434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 E MOCKINGBIRD LANE | ||||||||
| Address2: | #200 | ||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779042194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3165736291 | ||||||||
| FaxNumber: | 3615762434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 10/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | H6311 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | MDH6311 | 01 | TX | WORKERS COMPENSATION | OTHER | 87W114 | 01 | TX | BLUE CROSS | OTHER | 115106001 | 05 | TX | MEDICAID | 115106003 | 05 | TX | MEDICAID |