Provider Demographics
NPI:1952316390
Name:FARMINGTON FAMILY MEDICAL LLC
Entity Type:Organization
Organization Name:FARMINGTON FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:ZIAD
Authorized Official - Last Name:ABDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-267-1001
Mailing Address - Street 1:199 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-3077
Mailing Address - Country:US
Mailing Address - Phone:479-267-1001
Mailing Address - Fax:479-267-1026
Practice Address - Street 1:199 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-3077
Practice Address - Country:US
Practice Address - Phone:479-267-1001
Practice Address - Fax:479-267-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156125002Medicaid
AR156125002Medicaid