NPIMap

Organization Active NPI

Stephen Kennedy DO LLC

  • Family Medicine Physician
  • Osceola, IN
National Provider Identifier
1114115045
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02001650A Issued in IN
Legal business name
STEPHEN KENNEDY DO LLC
Practice address
1415 Lincoln Way W
Suite O
Osceola, IN 46561-2062
Phone
(574) 674-6499
Fax
(574) 674-6490
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stephen D Kennedy, D.O.
Title
President
Phone
(574) 255-4733

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 02001650A IN Primary

Addresses

Primary practice location

1415 Lincoln Way W
Suite O
Osceola, IN 46561-2062

Mailing address

1415 Lincoln Way W
Suite O
Osceola, IN 46561-2062
Phone (574) 674-6499

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1114115045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 LINCOLN WAY W",
            "address_2": "SUITE O",
            "city": "OSCEOLA",
            "state": "IN",
            "postal_code": "465612062",
            "telephone_number": "574-674-6499",
            "fax_number": "574-674-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 LINCOLN WAY W",
            "address_2": "SUITE O",
            "city": "OSCEOLA",
            "state": "IN",
            "postal_code": "465612062",
            "telephone_number": "574-674-6499",
            "fax_number": "574-674-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN KENNEDY DO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-255-4733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02001650A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Osceola, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.