MEDICARE: FAMILY HEALTH CARE

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	363LF0000X	Family Nurse Practitioner

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	:	1992970727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CARE

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	:	MRS. AMY D LEDBETTER
Credential	:
Telephone Number	:	573-651-4488

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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Directions to “FAMILY HEALTH CARE ” Practice Location

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