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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