FORREST CITY FAMILY PRACTICE CLINIC PA NPI 1649396979

NPI Information

NPI: 1649396979
Provider Name: FORREST CITY FAMILY PRACTICE CLINIC, PA
Classification: Family Medicine - 207QA0505X
Entity Type: Organization

Specialization: Adult Medicine

CLIA Number: 04D0869754

Address:
902 HOLIDAY DR
SUITE 101
FORREST CITY, AR
ZIP 72335
Phone: (870) 630-1256
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FORREST CITY FAMILY PRACTICE CLINIC, PA is an adult medicine family medicine in Forrest City, AR. The provider is definition to come. FORREST CITY FAMILY PRACTICE CLINIC, PA NPI is 1649396979. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

902 HOLIDAY DR
SUITE 101
FORREST CITY, AR
ZIP 72335-183
Phone: (870) 630-1256

The provider's authorized official is Neida Byrd .
The authorized official title is Billing Manager and has the following contact phone number (901) 737-3071.

The CLIA number assigned to this NPI record is 04D0869754 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/21/2007 and was last updated on 12/1/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0000X	Family Medicine	Adolescent Medicine	R3762	ARKANSAS	No
2	207QG0300X	Family Medicine	Geriatric Medicine	R3762	ARKANSAS	No
3	207QA0505X	Family Medicine	Adult Medicine	R3762	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	R3762	MEDICARE ID-TYPE UNSPECIFIED	ARKANSAS	MEDICARE GROUP
2	51280	OTHER	ARKANSAS	BCBS INDV NUMBER
3	113530001	MEDICAID	ARKANSAS
4	R3762	OTHER	ARKANSAS	BCBS GROUP ID
5	51280	MEDICARE ID-TYPE UNSPECIFIED	ARKANSAS	MEDICARE INDV
6	DO4484	MEDICARE UPIN
7	=========	OTHER		TAX ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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