| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 2200 Ada Ave, Conway, Arkansas |
| Authorized Official Name and Position | Connie Wear (OFFICE MANAGER) |
| Authorized Official Contact | 5015135793 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 757 Conway AR 72033-0757 Ph: (501) 513-5793 | 2200 Ada Ave Conway AR 72034-4985 Ph: (501) 513-5444 |
| NPI Number | 1861725871 |
|---|---|
| Provider Enumeration Date | 09/09/2009 |
| Last Update Date | 09/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861725871 | NPI | - | NPPES |
| C5964 | Other | AR | BLUE CROSS BLUE SHIELD |
| 177833002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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