Provider Demographics
NPI:1033113741
Name:THE FAMILY CLINIC OF NASHVILLE, P.A.
Entity Type:Organization
Organization Name:THE FAMILY CLINIC OF NASHVILLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-845-1933
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0549
Mailing Address - Country:US
Mailing Address - Phone:870-845-1933
Mailing Address - Fax:
Practice Address - Street 1:1400 LESLIE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-4027
Practice Address - Country:US
Practice Address - Phone:870-845-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-0293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56777OtherBLUE CROSS OF ARKANSAS
AR56777OtherHEALTH ADVANTAGE
AR14413000000OtherQUALCHOICE OF ARKANSAS
AR56777OtherBLUE ADVANTAGE
ARAR0001341OtherTRICARE/HUMANA
AR622147OtherUNITED HEALTHCARE
AR56777Medicare ID - Type Unspecified
AR56777OtherHEALTH ADVANTAGE