Provider Demographics
NPI:1063291151
Name:CPH FAMILY MEDICAL CARE
Entity type:Organization
Organization Name:CPH FAMILY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-278-7617
Mailing Address - Street 1:1905 E BEEBE CAPPS EXPY
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6973
Mailing Address - Country:US
Mailing Address - Phone:501-278-7617
Mailing Address - Fax:501-725-8813
Practice Address - Street 1:1905 E BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6973
Practice Address - Country:US
Practice Address - Phone:501-278-9679
Practice Address - Fax:501-725-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care