1053446047 NPI number — FAMILY FIRST HEALTHCENTER, INC.

Table of content: (NPI 1053446047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053446047 NPI number — FAMILY FIRST HEALTHCENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST HEALTHCENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053446047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MERCY LN
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-6442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-609-0224
Provider Business Mailing Address Fax Number:
501-609-0666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MERCY LN
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-6442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-609-0224
Provider Business Practice Location Address Fax Number:
501-609-0666
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODA
Authorized Official First Name:
FERDINAND
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-609-0224

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R4526 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181286002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5F730 . This is a "BLUE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00373655 . This is a "RAIL ROAD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 13278000001 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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