Provider Demographics
NPI:1891859021
Name:H AND T FAMILY HEALTHCARE CLINIC
Entity Type:Organization
Organization Name:H AND T FAMILY HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:LIZELLE H
Authorized Official - Last Name:TANGUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-623-3388
Mailing Address - Street 1:1 MERCY LANE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-627-3388
Mailing Address - Fax:501-623-3899
Practice Address - Street 1:1 MERCY LANE
Practice Address - Street 2:SUITE 301
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-627-3388
Practice Address - Fax:501-623-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C130Medicare ID - Type Unspecified