Provider Demographics
NPI:1083380372
Name:CANDOR CLINICIANS PA
Entity Type:Organization
Organization Name:CANDOR CLINICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-601-2314
Mailing Address - Street 1:4602 W WARBAL TRL
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8095
Mailing Address - Country:US
Mailing Address - Phone:479-601-2314
Mailing Address - Fax:888-664-5545
Practice Address - Street 1:153 E MONTE PAINTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4002
Practice Address - Country:US
Practice Address - Phone:479-601-2314
Practice Address - Fax:888-664-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty