# FORREST CITY FAMILY PRACTICE CLINIC, PA

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

## Provider details

- **NPI number:** 1649396979
- **Authorized official:** NEIDA BYRD (BILLING MANAGER)
- **Authorized official phone:** (901) 737-3071

## Contact information

- **Practice address:** 902 HOLIDAY DR, SUITE 101, FORREST CITY, AR 72335-9183
- **Practice address phone:** (870) 630-1256
- **Mailing address:** 902 HOLIDAY DR, SUITE 101, FORREST CITY, AR 72335-9183
- **Mailing address phone:** (870) 630-1256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | R3762 | AR | — |
| 207QA0505X | Adult Medicine Physician | R3762 | AR | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | R3762 | AR | — |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 12/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 113530001 | — | AR |
| 01 | — | 51280 | BCBS INDV NUMBER | AR |
| 01 | — | R3762 | BCBS GROUP ID | AR |