Basic Information
| Provider Information | |||||||||
| NPI: | 1518924968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SENEVEY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 5708 EDWARDS RANCH RD | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761094115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173364040 | ||||||||
| FaxNumber: | 8173366780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 10/09/2015 | ||||||||
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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 | 208000000X | D2591 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | D2591 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 83224X | 01 | TX | BCBS | OTHER | BCBS-TX | 01 | TX | 8FE404 | OTHER | 130900704 | 01 | TX | MEDICAID EPSDT | OTHER | 133486402 | 05 | TX | MEDICAID | 133486408 | 05 | TX | MEDICAID | 10028674 | 01 | TX | AMERIGROUP | OTHER | 4138420 | 01 | TX | AETNA | OTHER |