SHANE HIGGINBOTHAM MD PA NPI 1033129713

NPI Information

  • NPI: 1033129713
  • Provider Name: SHANE HIGGINBOTHAM MD PA
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: HIGGINBOTHAM FAMILY CLINIC
  • CLIA Number: 04D2027363
  • Address: 1002 SCHNEIDER DR
    SUITE 104
    MALVERN, AR
    ZIP 72104
  • Phone: (501) 332-7981

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NPI Details

SHANE HIGGINBOTHAM MD PA is a family medicine in Malvern, AR. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SHANE HIGGINBOTHAM MD PA NPI is 1033129713. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Higginbotham Family Clinic.

The provider's business location address is:

1002 SCHNEIDER DR
SUITE 104
MALVERN, AR
ZIP 72104-816
Phone: (501) 332-7981
Fax: (501) 337-9964

The provider's authorized official is Kim Overton .
The authorized official title is Office Manager and has the following contact phone number (501) 337-9994.

The CLIA number assigned to this NPI record is 04D2027363 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/8/2006 and was last updated on 5/6/2021.

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
1207Q00000XFamily MedicineE0968ARKANSASYes
2363A00000XPhysician AssistantPA251ARKANSASNo

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
1205795002MEDICAIDARKANSAS

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: 11/21/2025

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