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General NPI Number Information
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NPI Number | 1841631371
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Entity Type | Organization
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Legal Business Name | STABILITY PLUS LLC
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 1910 WINDSOR AVE
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City | SPRINGDALE
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State | AR
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Zip | 72764-9316
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Country | US
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Telephone | 479-285-1255
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Fax | 479-439-5606
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Provider Business Mailing Address
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Address Line | 1910 WINDSOR AVE
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City | SPRINGDALE
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State | AR
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Zip | 72764-9316
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Country | US
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Telephone | 479-285-1255
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Fax | 479-439-5606
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Authorized Official
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Title or Position | CEO / OWNER
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Name | BEN DE MIRANDA
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Credential | MD
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Telephone | 479-285-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E6411
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License Number State | AR
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