Provider Demographics
NPI:1396701041
Name:FAMILY MEDICINE CLINIC, P.A.
Entity type:Organization
Organization Name:FAMILY MEDICINE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-321-9292
Mailing Address - Street 1:216 GARRISON ST.
Mailing Address - Street 2:STE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7379
Mailing Address - Country:US
Mailing Address - Phone:501-321-9292
Mailing Address - Fax:877-791-3078
Practice Address - Street 1:216 GARRISON ST.
Practice Address - Street 2:STE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7379
Practice Address - Country:US
Practice Address - Phone:501-321-9292
Practice Address - Fax:877-791-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-0612207Q00000X
AR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150040002Medicaid
AR150040002Medicaid