Provider Demographics
NPI:1861455057
Name:BOWLIN-CUMMINS PA
Entity type:Organization
Organization Name:BOWLIN-CUMMINS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-329-3824
Mailing Address - Street 1:2425 DAVE WARD DR
Mailing Address - Street 2:STE 401
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-329-3824
Mailing Address - Fax:501-327-2957
Practice Address - Street 1:2425 DAVE WARD DR
Practice Address - Street 2:STE 401
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-329-3824
Practice Address - Fax:501-327-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156305729Medicaid
AR5B578OtherBLUE CROSS BLUE SHEILD
AR043853Medicare Oscar/Certification