Basic Information
| Provider Information | |||||||||
| NPI: | 1639357312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY FIRST HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725019419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703070001 | ||||||||
| FaxNumber: | 8703070395 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | BATESVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725019419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703070001 | ||||||||
| FaxNumber: | 8703070395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SHELLEY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8703070001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MC2605 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.