Organization
PCMC-CONWAY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN PAUL WORNOCK (PRESIDENT)
(501) 279-9000
Entity
Organization
Contact information
Practice address
1014 HARKRIDER ST, SUITE B, CONWAY, AR 72032-4404
(501) 327-7100
(501) 327-7121
Mailing address
1014 HARKRIDER ST, SUITE B, CONWAY, AR 72032-4404
(501) 327-7100
(501) 327-7121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1057
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386614097
—
AR
Enumeration date
06/25/2008
Last updated
06/25/2008
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