Provider Demographics
NPI:1083678437
Name:MCGEHEE FAMILY CLINIC PA
Entity Type:Organization
Organization Name:MCGEHEE FAMILY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-222-6131
Mailing Address - Street 1:601 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MC GEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-2108
Mailing Address - Country:US
Mailing Address - Phone:870-222-6131
Mailing Address - Fax:870-222-5909
Practice Address - Street 1:601 HOLLY ST
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2108
Practice Address - Country:US
Practice Address - Phone:870-222-6131
Practice Address - Fax:870-222-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-0302261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124966729Medicaid
AR56862OtherBLUE CROSS BLUE SHIELD
AR102089001Medicaid
AR102089001Medicaid
AR56862Medicare PIN