Providence Family Medicine Clinic INC

NPI #1932690617 in Conway, Arkansas

Provider Information

NPI Number: 1932690617
Entity Type: Organization
Organization Name: Providence Family Medicine Clinic INC
Primary Specialty: Family Medicine
Enumeration Date: May 29, 2018
Last Updated: May 29, 2018

Practice Location

Address: 3900 DAVE WARD DR
City: Conway
State: Arkansas
ZIP Code: 72034-5583
Phone: (501) 499-1086

Authorized Official

Name: DR. MOHAMMAD IDRIS, MD
Title: PRESIDENT
Phone: (501) 499-1086

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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