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General NPI Number Information
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NPI Number | 1699729095
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Entity Type | Organization
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Legal Business Name | COMMUNITY PHYSICIANS GROUP
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | 311 MORROW ST N
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City | MENA
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State | AR
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Zip | 71953-2516
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Country | US
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Telephone | 479-394-6100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 295
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City | LOCKESBURG
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State | AR
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Zip | 71846-0295
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Country | US
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Telephone | 870-289-5865
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Fax | 870-289-6993
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Authorized Official
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Title or Position | CEO
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Name | TIM BOWEN
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Credential |
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Telephone | 870-289-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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