Provider Demographics
NPI:1104875962
Name:HILL, STEVEN FREDERICK (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:FREDERICK
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0168
Mailing Address - Country:US
Mailing Address - Phone:360-875-4502
Mailing Address - Fax:360-875-5962
Practice Address - Street 1:810 ALDER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586-0168
Practice Address - Country:US
Practice Address - Phone:360-875-4502
Practice Address - Fax:360-875-5962
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114610Medicaid
WA0156684OtherL&I PROVIDER ID
WA9633HIOtherREGENCE RIDER NO
GAB33434Medicare ID - Type Unspecified
WA0156684OtherL&I PROVIDER ID