Provider Demographics
NPI:1740797422
Name:HEALTHVILLE PLLC
Entity type:Organization
Organization Name:HEALTHVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-282-0843
Mailing Address - Street 1:11219 FINANCIAL CENTRE PKWY STE 316
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3895
Mailing Address - Country:US
Mailing Address - Phone:501-747-1827
Mailing Address - Fax:
Practice Address - Street 1:11219 FINANCIAL CENTRE PKWY STE 316
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3895
Practice Address - Country:US
Practice Address - Phone:501-747-1827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty