Provider Demographics
NPI:1043493992
Name:COMMUNITY PHYSICIANS GROUP
Entity Type:Organization
Organization Name:COMMUNITY PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-549-3079
Mailing Address - Street 1:PO BOX 1374
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-1374
Mailing Address - Country:US
Mailing Address - Phone:479-549-3079
Mailing Address - Fax:479-549-3275
Practice Address - Street 1:419 S WILLIAMS
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965
Practice Address - Country:US
Practice Address - Phone:918-723-5456
Practice Address - Fax:918-723-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCI2712OtherRR MEDICARE
AR135299002Medicaid
AR5C090OtherBCBS
OK100747540AMedicaid
ARCI2710OtherRR MEDICARE
AR5C090OtherBCBS
AR135299002Medicaid
OK400522014Medicare PIN