Provider Demographics
NPI:1831388578
Name:DUMAS FAMILY CLINIC, PA
Entity type:Organization
Organization Name:DUMAS FAMILY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:870-692-6137
Mailing Address - Street 1:705 MEADOR DR
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-2826
Mailing Address - Country:US
Mailing Address - Phone:870-382-2101
Mailing Address - Fax:870-382-2103
Practice Address - Street 1:705 MEADOR DR
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2826
Practice Address - Country:US
Practice Address - Phone:870-382-2101
Practice Address - Fax:870-382-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01695261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16831002Medicaid
AR5X663Medicare PIN
AR5X663F929Medicare PIN