Basic Information
| Provider Information | |||||||||
| NPI: | 1104105972 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHIPLEY & SILLS FAMILY PRACTICE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4003 MASSARD RD | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792263836 | ||||||||
| FaxNumber: | 4794345987 | ||||||||
| Practice Location | |||||||||
| Address1: | 4003 MASSARD RD. | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792263836 | ||||||||
| FaxNumber: | 4794345987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 07/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | PULLIAM | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4792263836 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.