Provider Demographics
NPI:1285145169
Name:ARKANSAS FAMILY CARE NETWORK
Entity type:Organization
Organization Name:ARKANSAS FAMILY CARE NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-1690
Mailing Address - Street 1:220 N SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4389
Mailing Address - Country:US
Mailing Address - Phone:479-498-0858
Mailing Address - Fax:479-498-0809
Practice Address - Street 1:220 N SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4389
Practice Address - Country:US
Practice Address - Phone:479-498-0858
Practice Address - Fax:479-498-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR213751002Medicaid