MEDICARE: THE FAMILY CLINIC OF NASHVILLE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MC-0293	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56777	OTHER	AR	BLUE CROSS OF ARKANSAS
2	56777	OTHER	AR	HEALTH ADVANTAGE
3	14413000000	OTHER	AR	QUALCHOICE OF ARKANSAS
4	56777	OTHER	AR	BLUE ADVANTAGE
5	AR0001341	OTHER	AR	TRICARE/HUMANA
6	622147	OTHER	AR	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1033113741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY CLINIC OF NASHVILLE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-0549
Country	:	US
Telephone Number	:	870-845-1933
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 LESLIE ST
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-4027
Country	:	US
Telephone Number	:	870-845-1933
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JOE D KING
Credential	:	M.D.
Telephone Number	:	870-845-1933

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/13/2007

Similar Medicare Providers

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Practice Location Address:

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1538638275 — JESSICA JANAY BAILEY MNSC, APRN, NP-C
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Directions to “THE FAMILY CLINIC OF NASHVILLE, P.A. ” Practice Location

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