Healthcare Provider Details

I. General information

NPI: 1013255777
Provider Name (Legal Business Name): ACCESS FAMILY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WINTERBROOK DR
CONWAY AR
72034-3564
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-7930
  • Fax:
Mailing address:
  • Phone: 479-498-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTI SHORT
Title or Position: CREDENTIALING OFFICER
Credential:
Phone: 479-498-6700