Provider Demographics
NPI:1194962951
Name:STEADHAM, MATTHEW K (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:STEADHAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S SANTA FE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4189
Mailing Address - Country:US
Mailing Address - Phone:785-452-7562
Mailing Address - Fax:785-452-7105
Practice Address - Street 1:501 S SANTA FE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4189
Practice Address - Country:US
Practice Address - Phone:785-452-7562
Practice Address - Fax:785-452-7105
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01285363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200594250CMedicaid
KSP01060618Medicare PIN
KS200594250BMedicaid
KSKA2473004Medicare PIN