| Family Practice Center | |
|
194 Shakerag Road Clinton AR 72031 | |
| (501) 745-2800 | |
| (501) 745-8864 |
| Full Name | Family Practice Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 194 Shakerag Road, Clinton, Arkansas |
| Authorized Official Name and Position | Brenda Lynn Smith (OFFICE MANAGER) |
| Authorized Official Contact | 5017452800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Practice Center Po Box 1100 Clinton AR 72031-1100 Ph: (501) 745-2800 | Family Practice Center 194 Shakerag Road Clinton AR 72031 Ph: (501) 745-2800 |
| NPI Number | 1013108240 |
|---|---|
| Provider Enumeration Date | 08/05/2007 |
| Last Update Date | 09/23/2011 |
| Medicare PECOS PAC ID | 2365706504 |
|---|---|
| Medicare Enrollment ID | O20180516000134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013108240 | NPI | - | NPPES |
| 106212001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | N6056 (Arkansas) | Primary |
| Provider Name | Jose E Abiseid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154391514 PECOS PAC ID: 2163507740 Enrollment ID: I20080306000256 |
| Provider Name | Caitlin A Shull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437668175 PECOS PAC ID: 3072860162 Enrollment ID: I20180720000188 |
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