Healthcare Provider Details

I. General information

NPI: 1053446047
Provider Name (Legal Business Name): FAMILY FIRST HEALTHCENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY LN SUITE 301
HOT SPRINGS AR
71913-6442
US

IV. Provider business mailing address

1 MERCY LN SUITE 301
HOT SPRINGS AR
71913-6442
US

V. Phone/Fax

Practice location:
  • Phone: 501-609-0224
  • Fax: 501-609-0666
Mailing address:
  • Phone: 501-609-0224
  • Fax: 501-609-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4526
License Number StateAR

VIII. Authorized Official

Name: FERDINAND T RODA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-609-0224