MEDICARE: FAMILY HEALTH CARE LLC

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

General Provider Information

NPI Number	:	1285177147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	350 MAIN ST
Second Line	:	STE 4
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-7423
Country	:	US
Telephone Number	:	870-625-3111
Fax Number	:	870-625-3118

Provider Business Practice Location Address
First Line	:	350 MAIN ST
Second Line	:	STE 4
City	:	MAMMOTH SPRING
State	:	AR
Zip	:	72554-7423
Country	:	US
Telephone Number	:	870-625-3111
Fax Number	:	870-625-3118

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	AMELIA D LEDBETTER
Credential	:
Telephone Number	:	573-335-4715

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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