1326357823 NPI number — STEFANIE MARTIN FARINHOLT BSOT

Table of content: STEFANIE MARTIN FARINHOLT BSOT (NPI 1326357823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326357823 NPI number — STEFANIE MARTIN FARINHOLT BSOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARINHOLT
Provider First Name:
STEFANIE
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSOT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326357823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10755 LAKESIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72745-9382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-633-5592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 W CENTERTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72719-8701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-795-1260
Provider Business Practice Location Address Fax Number:
479-795-1261
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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