4TH Street Medical Care PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

602329907 Issued in WA

Legal business name

4TH STREET MEDICAL CARE PLLC

Practice address

1602 4TH St
Marysville, WA 98270-5014

Phone

(360) 659-4141

Fax

(360) 659-1712

NPI assigned

Feb 4, 2008

Organization subpart

No

Name

Dr. Santosa Ho, M.D.

Title

Owner

Phone

(360) 659-4141

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 8, 2014.

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417996800000",
    "number": "1659559409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 4TH ST",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982705014",
            "telephone_number": "360-659-4141",
            "fax_number": "360-659-1712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 4TH ST",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982705014",
            "telephone_number": "360-659-4141",
            "fax_number": "360-659-1712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4TH STREET MEDICAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2014-12-08",
        "status": "A",
        "authorized_official_last_name": "HO",
        "authorized_official_first_name": "SANTOSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-659-4141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "602329907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 1918 Winter Street Operating Co LLC
• 1918 Winter Street Operating Co LLC
• A-Kahdeh LLC
• Lance Todd Aalbu, MPT, CSCS
• Tamsie M Aalbu
• Eric Michael Abarr, PA-C
• Luis Acevedo Rodriguez, DDS

• All providers in Marysville, WA
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.