Provider Demographics
NPI:1164472478
Name:AR MEDICAL LLC
Entity Type:Organization
Organization Name:AR MEDICAL LLC
Other - Org Name:HINESVILLE FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FIROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PATKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-625-7597
Mailing Address - Street 1:809 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1449
Mailing Address - Country:US
Mailing Address - Phone:478-625-7597
Mailing Address - Fax:478-625-8364
Practice Address - Street 1:502 E GENERAL STEWART WAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2629
Practice Address - Country:US
Practice Address - Phone:912-368-4169
Practice Address - Fax:912-368-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055918207R00000X
GA052399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA113965Medicare Oscar/Certification