Healthcare Provider Details

I. General information

NPI: 1043493992
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S WILLIAMS
WESTVILLE OK
74965
US

IV. Provider business mailing address

PO BOX 1374
SILOAM SPRINGS AR
72761-1374
US

V. Phone/Fax

Practice location:
  • Phone: 918-723-5456
  • Fax: 918-723-4080
Mailing address:
  • Phone: 479-549-3079
  • Fax: 479-549-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY E CHAMBERS
Title or Position: BILLING MANAGER
Credential:
Phone: 479-549-3079