Provider Demographics
NPI:1104337278
Name:HILL, STEPHEN WENDELL
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WENDELL
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:23882-2728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7214 PARHAM RD
Practice Address - Street 2:
Practice Address - City:STONY CREEK
Practice Address - State:VA
Practice Address - Zip Code:23882-2728
Practice Address - Country:US
Practice Address - Phone:434-637-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69024175172A00000X
347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347E00000XTransportation ServicesTransportation BrokerGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty