=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710268479
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHANIE HO MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2011
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 S I ST
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72901-4908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-434-3779
-----------------------------------------------------
Fax | 479-434-3895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 S I ST
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72901-4908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-434-3779
-----------------------------------------------------
Fax | 479-434-3895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHANIE HO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-434-3779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | E-6359
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------