Organization
COMMUNITY PHYSICIANS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY E CHAMBERS (BILLING MANAGER)
(479) 549-3079
Entity
Organization
Contact information
Practice address
419 S WILLIAMS, WESTVILLE, OK 74965
(918) 723-5456
(918) 723-4080
Mailing address
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100747540A
—
OK
05
—
135299002
—
AR
01
—
5C090
BCBS
AR
01
—
CI2710
RR MEDICARE
AR
01
—
CI2712
RR MEDICARE
OK
Enumeration date
12/14/2007
Last updated
12/04/2009
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