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General NPI Number Information
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NPI Number | 1013255777
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Entity Type | Organization
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Legal Business Name | ACCESS FAMILY MEDICINE, INC.
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 1505 WINTERBROOK DR
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City | CONWAY
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State | AR
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Zip | 72034-3564
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Country | US
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Telephone | 479-968-7930
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 479-498-6700
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING OFFICER
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Name | KRISTI SHORT
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Credential |
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Telephone | 479-498-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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