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Organization
INTEGRATED COMMUNITY CLINICS PA
Active
Organization
INTEGRATED COMMUNITY CLINICS PA
Active
Other names
Community Physicians Group
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY CHAMBERS (BILLING MANAGER)
(479) 549-3079
Entity
Organization
Contact information
Practice address
1101-2 N PROGRESS AVENUE, SILOAM SPRINGS, AR 72761-4343
(479) 549-3079
(479) 549-3275
Mailing address
1101-2 N PROGRESS AVENUE, PO BOX 1374, SILOAM SPRINGS, AR 72761-1374
(479) 549-3079
(479) 549-3275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100747540A
—
OK
05
—
135299002
—
AR
01
—
5C090
BCBS
AR
Enumeration date
05/03/2006
Last updated
02/13/2012
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