B C STUFFLEBAM, MD, LLC (NPI# 1043453707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043453707 |
| Entity Type | Organization |
| Organization Name | B C STUFFLEBAM, MD, LLC |
| Practice Address |
629 Sable Dr Centralia IL 62801-4472 |
| Practice Telephone | 6185330727 |
| Practice Fax Number | 6185331464 |
| Mailing Telephone | 6185330727 |
| Mailing Fax Number | 6185331464 |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2009-04-10 |
| Authorized Official Name | BRADLEY CHRISTIAN STUFFLEBAM (MANAGER) |
| Authorized Official Telephone | 6185330727 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
036058847 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
629 SABLE DR |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-4472 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275558249 | Bradley C Stufflebam | Radiology | 629 Sable Dr, Centralia, IL 62801-4472 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275558249 | Bradley C Stufflebam | Radiology | 629 Sable Dr, Centralia, IL 62801-4472 | 2006-07-12 |
| 1801882915 | Southwest Washington Diagnostics Lp | Radiology | 910 S Scheuber Rd, Centralia, WA 98531-9027 | 2005-09-23 |
| 1699108142 | California Advanced Imaging Medical Assoc, Inc. | Radiology | 910 S Scheuber Rd, Centralia, WA 98531-9027 | 2013-08-19 |
| 1255677118 | South Sound Radiology - Lewis County | Radiology | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2012-12-21 |
| 1679632970 | Robert J Killian | Radiology | 400 N Pleasant Ave, Radiology Dept, Centralia, IL 62801-3056 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376196220 | Parvathamma Imaging Services, LLC | Radiology | 7431 S East End Ave Ste 2, Chicago, IL 60649-3611 | 2019-07-19 |
| 1730652017 | Diaspora Radiology, Sc | Radiology | 2602 Mulberry Ln, Northbrook, IL 60062-5937 | 2019-01-09 |
| 1225516842 | Tyler Jonathan Hinkel | Radiology | 33 W Ontario St Apt 46f, Chicago, IL 60654 | 2018-08-06 |
| 1043796543 | Quantum Medical Radiology of California, P.C. | Radiology | 374 W Seminary Ave, Wheaton, IL 60187-5002 | 2018-07-17 |
| 1215429501 | The Open Mri Center | Radiology | 3123 Williamson County Pkwy, Marion, IL 62959-5235 | 2018-06-01 |
| 1649769746 | Envision Medical Imaging, LLC | Radiology | 915 National Pkwy Ste 915-20, Schaumburg, IL 60173-5160 | 2018-05-03 |
| 1831687250 | Michael Patrick Murphy | Radiology | 807 Davis St. Unit 707, Evanston, IL 60201 | 2018-05-01 |
| 1366976631 | Ali Mostafa Serhal | Radiology | 240 E. Huron St, Suite 1-203, Chicago, IL 60617 | 2017-04-13 |
| 1710427737 | Dorothea A Nazos | Radiology | 1810 Parkside Dr, Shorewood, IL 60404-0684 | 2017-02-24 |
| 1194275941 | Florida United Radiology, Lc | Radiology | 7 Pear Tree Ct, Charleston, IL 61920-4415 | 2016-10-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.