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General NPI Number Information
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NPI Number | 1912340720
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Entity Type | Organization
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Legal Business Name | STAYING HEALTHY MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 05/16/2020
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Provider Practice Location Address
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Address Line | 4700 DEXTER DR SUITE 300
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City | PLANO
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State | TX
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Zip | 75093-5294
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Country | US
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Telephone | 214-501-8135
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 MAHOGANY LN
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City | COPPER CANYON
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State | TX
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Zip | 75077-8546
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Country | US
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Telephone | 214-501-8135
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHANIE HAN
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Credential | M.D.
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Telephone | 469-569-7162
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | L0903
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License Number State | TX
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