Provider Demographics
NPI:1053446047
Name:FAMILY FIRST HEALTHCENTER, INC.
Entity Type:Organization
Organization Name:FAMILY FIRST HEALTHCENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:T
Authorized Official - Last Name:RODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-609-0224
Mailing Address - Street 1:1 MERCY LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6442
Mailing Address - Country:US
Mailing Address - Phone:501-609-0224
Mailing Address - Fax:501-609-0666
Practice Address - Street 1:1 MERCY LN
Practice Address - Street 2:SUITE 301
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6442
Practice Address - Country:US
Practice Address - Phone:501-609-0224
Practice Address - Fax:501-609-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR4526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181286002Medicaid
AR5F730OtherBLUE
ARP00373655OtherRAIL ROAD
AR13278000001OtherQUALCHOICE
ARC44480Medicare UPIN
AR13278000001OtherQUALCHOICE