| Providence Family Medicine Clinic Inc | |
|
3900 Dave Ward Dr Conway AR 72034-5583 | |
| (501) 499-1086 | |
| Not Available |
| Full Name | Providence Family Medicine Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3900 Dave Ward Dr, Conway, Arkansas |
| Authorized Official Name and Position | Mohammad Idris (PRESIDENT) |
| Authorized Official Contact | 5014991086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Family Medicine Clinic Inc 8 Oak Tree Cir Conway AR 72032-2112 Ph: (501) 499-1086 | Providence Family Medicine Clinic Inc 3900 Dave Ward Dr Conway AR 72034-5583 Ph: (501) 499-1086 |
| NPI Number | 1932690617 |
|---|---|
| Provider Enumeration Date | 05/29/2018 |
| Last Update Date | 05/29/2018 |
| Medicare PECOS PAC ID | 2668721960 |
|---|---|
| Medicare Enrollment ID | O20180820003124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932690617 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohammad Idris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407086200 PECOS PAC ID: 4789833997 Enrollment ID: I20121003000809 |
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