Healthcare Provider Details

I. General information

NPI: 1063291151
Provider Name (Legal Business Name): CPH FAMILY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E BEEBE CAPPS EXPY
SEARCY AR
72143-6973
US

IV. Provider business mailing address

1905 E BEEBE CAPPS EXPY
SEARCY AR
72143-6973
US

V. Phone/Fax

Practice location:
  • Phone: 501-278-9679
  • Fax: 501-725-8813
Mailing address:
  • Phone: 501-278-7617
  • Fax: 501-725-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON PUTMAN
Title or Position: MANAGER
Credential: APRN
Phone: 501-278-7617