Organization
BOWLIN-CUMMINS PA
Active
Other names
Banister-Lieblong Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LANDER A SMITH MD (CHIEF FINANCIAL OFFICER)
(501) 329-3824
Entity
Organization
Contact information
Practice address
2425 DAVE WARD DR, STE 401, CONWAY, AR 72034
(501) 329-3824
(501) 327-2957
Mailing address
2425 DAVE WARD DR, STE 401, CONWAY, AR 72034
(501) 329-3824
(501) 327-2957
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156305729
—
AR
01
—
5B578
BLUE CROSS BLUE SHEILD
AR
Enumeration date
04/10/2006
Last updated
01/06/2015
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