Provider Demographics
NPI:1174044952
Name:DR. STEPHEN C. FISHER LLC
Entity type:Organization
Organization Name:DR. STEPHEN C. FISHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-518-5111
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:479-498-6700
Mailing Address - Fax:
Practice Address - Street 1:1359 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9554
Practice Address - Country:US
Practice Address - Phone:479-744-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment