Provider Demographics
NPI:1518957240
Name:FAMILY PRACTICE ASSOCIATES OF CLARKSVILLE,PA
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF CLARKSVILLE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-754-4721
Mailing Address - Street 1:23 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4432
Mailing Address - Country:US
Mailing Address - Phone:479-754-4721
Mailing Address - Fax:844-584-4213
Practice Address - Street 1:23 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4432
Practice Address - Country:US
Practice Address - Phone:479-754-4721
Practice Address - Fax:844-584-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1606173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127426002Medicaid
AR127426002Medicaid