Basic Information
| Provider Information | |||||||||
| NPI: | 1720733124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMC FQHC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4196 HIGHWAY 62 412 STE A | ||||||||
| Address2: | |||||||||
| City: | HARDY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725428002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708561202 | ||||||||
| FaxNumber: | 8708562107 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 S BAY DR | ||||||||
| Address2: | |||||||||
| City: | BAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724119482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707701920 | ||||||||
| FaxNumber: | 8709947488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | BIBB | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 8708561202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.