MEDICARE: FAMILY MEDICAL CARE, PA

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	C7548	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080191764	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255371753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CARE, PA

Provider Business Mailing Address
First Line	:	PO BOX 1018
Second Line	:	2225 HIGHWAY 110 WEST
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-1018
Country	:	US
Telephone Number	:	501-362-0048
Fax Number	:	501-362-8815

Provider Business Practice Location Address
First Line	:	2225 HIGHWAY 110 W
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-3404
Country	:	US
Telephone Number	:	501-362-0048
Fax Number	:	501-362-8815

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. GRANVILLE LEROY VAUGHAN III
Credential	:	M.D.
Telephone Number	:	501-362-0048

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/30/2008

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Directions to “FAMILY MEDICAL CARE, PA ” Practice Location

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