| Aspire Oms, Llc | |
|
911 Wall St Ste C Valparaiso IN 46383-2553 | |
| (219) 462-9599 | |
| (219) 464-0369 |
| Full Name | Aspire Oms, Llc |
|---|---|
| Speciality | Dentist |
| Location | 911 Wall St Ste C, 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 |
|---|---|
| Aspire Oms, Llc 61 W 86th Ave Merrillville IN 46410-7098 Ph: (219) 736-1401 | Aspire Oms, Llc 911 Wall St Ste C Valparaiso IN 46383-2553 Ph: (219) 462-9599 |
| NPI Number | 1013642107 |
|---|---|
| Provider Enumeration Date | 07/21/2022 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 7315316015 |
|---|---|
| Medicare Enrollment ID | O20221219001656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013642107 | 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 |
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