Provider Demographics
NPI:1992806376
Name:FAMILY HEALTH CARE, LLC
Entity type:Organization
Organization Name:FAMILY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:870-625-3111
Mailing Address - Street 1:350 MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-7425
Mailing Address - Country:US
Mailing Address - Phone:870-625-3111
Mailing Address - Fax:870-625-3118
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-7425
Practice Address - Country:US
Practice Address - Phone:870-625-3111
Practice Address - Fax:870-625-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
ARAO2947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F672OtherMEDICARE PART B
AR043864Medicare Oscar/Certification