| College Park Family Clinic Pa | |
|
2511-a College Ave Conway AR 72034 | |
| (501) 327-6041 | |
| (501) 327-6043 |
| Full Name | College Park Family Clinic Pa |
|---|---|
| Speciality | Emergency Medicine |
| Location | 2511-a College Ave, Conway, Arkansas |
| Authorized Official Name and Position | Gil E Johnson (CEO PRESIDENT) |
| Authorized Official Contact | 5013276041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| College Park Family Clinic Pa 2511-a College Ave Conway AR 72034 Ph: (501) 327-6041 | College Park Family Clinic Pa 2511-a College Ave Conway AR 72034 Ph: (501) 327-6041 |
| NPI Number | 1861478232 |
|---|---|
| Provider Enumeration Date | 12/19/2005 |
| Last Update Date | 09/11/2025 |
| Medicare PECOS PAC ID | 7911384052 |
|---|---|
| Medicare Enrollment ID | O20220511001978 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861478232 | NPI | - | NPPES |
| 11451000000 | Other | AR | QC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C6340 (Arkansas) | Secondary |
| 208000000X | Pediatrics | C6340 (Arkansas) | Secondary |
| 207P00000X | Emergency Medicine | C6340 (Arkansas) | Primary |
| Provider Name | Gil E Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356563241 PECOS PAC ID: 9133139421 Enrollment ID: I20060508000983 |
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