Provider Demographics
NPI:1124108162
Name:FAMILY DOCTORS CLINIC PA
Entity type:Organization
Organization Name:FAMILY DOCTORS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-741-8286
Mailing Address - Street 1:520 NORTH SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3528
Mailing Address - Country:US
Mailing Address - Phone:870-741-8286
Mailing Address - Fax:870-741-7481
Practice Address - Street 1:520 NORTH SPRING STREET
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3528
Practice Address - Country:US
Practice Address - Phone:870-741-8286
Practice Address - Fax:870-741-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
56746Medicare ID - Type Unspecified