Basic Information
| Provider Information | |||||||||
| NPI: | 1316988991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELTER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20452 | ||||||||
| Address2: | YPS CREDENTIALING | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432200452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144422406 | ||||||||
| FaxNumber: | 6144422410 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HIGHWAY 71 E | ||||||||
| Address2: | C/O SETON-SMITHVILLE REGIONAL HOSPITAL | ||||||||
| City: | SMITHVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789571730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122373214 | ||||||||
| FaxNumber: | 5122375768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 03/13/2014 | ||||||||
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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 | 367500000X | 571772 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8871UB | 01 | TX | BCBS OF TX | OTHER | 142952404 | 05 | TX | MEDICAID | 571772 | 01 | TX | STATE LICENSE NUMBER | OTHER |