Provider Demographics
NPI:1063618346
Name:HAMBY & HAMBY FAMILY WELLNESS CLINIC PLLC
Entity type:Organization
Organization Name:HAMBY & HAMBY FAMILY WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-922-9355
Mailing Address - Street 1:PO BOX 6968
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-0961
Mailing Address - Country:US
Mailing Address - Phone:479-420-4575
Mailing Address - Fax:
Practice Address - Street 1:30 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6668
Practice Address - Country:US
Practice Address - Phone:479-420-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131118001Medicaid
ARG35617Medicare UPIN
AR5K256Medicare ID - Type UnspecifiedJEFFREY HAMBY