Organization
PROVIDENCE FAMILY MEDICINE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD IDRIS MD (PRESIDENT)
(501) 499-1086
Entity
Organization
Contact information
Practice address
3900 DAVE WARD DR, CONWAY, AR 72034-5583
(501) 499-1086
Mailing address
8 OAK TREE CIR, CONWAY, AR 72032-2112
(501) 499-1086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/29/2018
Last updated
05/29/2018
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