Organization
FAMILY MEDICAL CARE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRANVILLE LEROY VAUGHAN III M.D. (OWNER/CEO)
(501) 362-0048
Entity
Organization
Contact information
Practice address
2225 HIGHWAY 110 W, HEBER SPRINGS, AR 72543-3404
(501) 362-0048
(501) 362-8815
Mailing address
PO BOX 1018, 2225 HIGHWAY 110 WEST, HEBER SPRINGS, AR 72543-1018
(501) 362-0048
(501) 362-8815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C7548
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080191764
RAILROAD MEDICARE
AR
05
—
149045002
—
AR
Enumeration date
06/07/2006
Last updated
07/30/2008
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