Provider Demographics
NPI:1992847818
Name:CONOVER CLINICS, INC.
Entity Type:Organization
Organization Name:CONOVER CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:CONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-795-0426
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-0034
Mailing Address - Country:US
Mailing Address - Phone:479-795-0426
Mailing Address - Fax:479-795-0427
Practice Address - Street 1:101 SUN MEADOW DR
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9610
Practice Address - Country:US
Practice Address - Phone:479-795-0426
Practice Address - Fax:479-795-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143769003Medicaid
AR143769003Medicaid
ARH24035Medicare UPIN