# RUSSELLVILLE FAMILY CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003805870
- **Authorized official:** MRS. JOY A PIKE (BUSINESS MANAGER)
- **Authorized official phone:** (479) 968-7170

## Contact information

- **Practice address:** 108 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
- **Practice address phone:** (479) 968-7170
- **Practice address fax:** (479) 968-7607
- **Mailing address:** PO BOX 1648, RUSSELLVILLE, AR 72811-1648
- **Mailing address phone:** (479) 968-7170
- **Mailing address fax:** (479) 968-7607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/14/2005
- **Last updated:** 03/11/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 119926002 | — | AR |
| 01 | — | 8772887600 | MEDICARE \# ISSUED BY GOVERMENT FOR RAILROAD CLAIMS | AR |