Healthcare Provider Details

I. General information

NPI: 1619410040
Provider Name (Legal Business Name): FIRST CARE FAMILY MEDICINE-MENA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 HIGHWAY 71 N
MENA AR
71953-8917
US

IV. Provider business mailing address

1661 AIRPORT RD SUITE D
HOT SPRINGS AR
71913-7951
US

V. Phone/Fax

Practice location:
  • Phone: 501-625-7500
  • Fax: 501-625-7777
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA LARIE SOUTHERLAND
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 501-625-7500