Healthcare Provider Details

I. General information

NPI: 1699729095
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MORROW ST N
MENA AR
71953-2516
US

IV. Provider business mailing address

PO BOX 295
LOCKESBURG AR
71846-0295
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-6100
  • Fax:
Mailing address:
  • Phone: 870-289-5865
  • Fax: 870-289-6993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM BOWEN
Title or Position: CEO
Credential:
Phone: 870-289-5865