# MEDICAL HOLISTIC CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770747990
- **Authorized official:** DR. KATIE ANNE STEVENSON DOM (MANAGING PARTNER)
- **Authorized official phone:** (386) 663-3003

## Contact information

- **Practice address:** 512 CANAL ST, NEW SMYRNA BEACH, FL 32168-7012
- **Practice address phone:** (386) 663-3003
- **Practice address fax:** (386) 663-3007
- **Mailing address:** 512 CANAL ST, NEW SMYRNA BEACH, FL 32168-7012
- **Mailing address phone:** (386) 663-3003
- **Mailing address fax:** (386) 663-3007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | OS9438 | FL | Yes |

## Other

- **Enumeration date:** 07/16/2008
- **Last updated:** 07/16/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 279979100 | MEDIPASS | FL |
| 05 | — | 279979100 | — | FL |