Healthcare Provider Details

I. General information

NPI: 1861455057
Provider Name (Legal Business Name): BOWLIN-CUMMINS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DR STE 401
CONWAY AR
72034
US

IV. Provider business mailing address

2425 DAVE WARD DR STE 401
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3824
  • Fax: 501-327-2957
Mailing address:
  • Phone: 501-329-3824
  • Fax: 501-327-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANDER A SMITH
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MD
Phone: 501-329-3824