# REGIONAL FAMILY MEDICINE PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1003814609
- **Authorized official:** JOHN GREGORY ELDERS MD (CEO)
- **Authorized official phone:** (870) 425-6971

## Contact information

- **Practice address:** 630 BURNETT DR, MOUNTAIN HOME, AR 72653-2941
- **Practice address phone:** (870) 425-6971
- **Practice address fax:** (870) 508-8900
- **Mailing address:** 630 BURNETT DR, MOUNTAIN HOME, AR 72653-2941
- **Mailing address phone:** (870) 425-6971
- **Mailing address fax:** (870) 508-8900

## Taxonomy

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

## Other

- **Enumeration date:** 07/08/2005
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 121500001 | — | AR |
| 01 | — | 5F307 | MEDICARE PTAN | AR |