| Banister-lieblong Clinic | |
|
2425 Dave Ward Dr Ste 401 Conway AR 72034 | |
| (501) 329-3824 | |
| (501) 327-2957 |
| Full Name | Banister-lieblong Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2425 Dave Ward Dr, Conway, Arkansas |
| Authorized Official Name and Position | Lander A Smith (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5013293824 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banister-lieblong Clinic 2425 Dave Ward Dr Ste 401 Conway AR 72034 Ph: (501) 329-3824 | Banister-lieblong Clinic 2425 Dave Ward Dr Ste 401 Conway AR 72034 Ph: (501) 329-3824 |
| NPI Number | 1861455057 |
|---|---|
| Provider Enumeration Date | 04/10/2006 |
| Last Update Date | 01/06/2015 |
| Medicare PECOS PAC ID | 5698725745 |
|---|---|
| Medicare Enrollment ID | O20050126000523 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861455057 | NPI | - | NPPES |
| 156305729 | Medicaid | AR | |
| 5B578 | Other | AR | BLUE CROSS BLUE SHEILD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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