| Entity Name: | DR. PETER STEPHENS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 04 Dec 1987 (37 years ago) |
| Document Number: | K05506 |
| FEI/EIN Number | 650019556 |
| Address: | % DR. PETER STEPHENS, 375 SW 32ND ST, OKEECHOBEE, FL, 34974 |
| Mail Address: | % DR. PETER STEPHENS, 375 SW 32ND ST, OKEECHOBEE, FL, 34974 |
| ZIP code: | 34974 |
| County: | Okeechobee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477863074 | 2010-10-15 | 2010-11-10 | 375 SW 32ND ST, OKEECHOBEE, FL, 349745919, US | 375 SW 32ND ST, OKEECHOBEE, FL, 349745919, US | |||||||||||||||||||||||
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| Phone | +1 863-763-0880 |
Authorized person
| Name | DR. PETER STEPHENS |
| Role | PRESIDENT |
| Phone | 8637630880 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | CH 3189 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE BCBS |
| Number | 88368 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STEPHENS, PETER | Agent | 375 SW 32ND ST, OKEECHOBEE, FL, 34974 |
| Name | Role | Address |
|---|---|---|
| STEPHENS, PETER | President | 375 SW 32ND ST, OKEECHOBEE, FL, 34974 |
| Name | Role | Address |
|---|---|---|
| STEPHENS, PETER | Director | 375 SW 32ND ST, OKEECHOBEE, FL, 34974 |
| Name | Role | Address |
|---|---|---|
| STEPHENS, TERESA L. | Vice President | 375 SW 32ND ST, OKEECHOBEE, FL, 34974 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
