Provider Demographics
NPI:1841597085
Name:VONDA GALE HOUCHIN, M.D. PA
Entity Type:Organization
Organization Name:VONDA GALE HOUCHIN, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/DOCOTOR
Authorized Official - Prefix:
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-578-5443
Mailing Address - Street 1:802 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432-1132
Mailing Address - Country:US
Mailing Address - Phone:870-578-5443
Mailing Address - Fax:870-578-9443
Practice Address - Street 1:802 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1132
Practice Address - Country:US
Practice Address - Phone:870-578-5446
Practice Address - Fax:870-578-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8123261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
55005OtherAPPLYING FOR A GROUP NPI