Basic Information
| Provider Information | |||||||||
| NPI: | 1760426043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEEHAN | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 PROGRESS AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727614343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795494010 | ||||||||
| FaxNumber: | 4795493302 | ||||||||
| Practice Location | |||||||||
| Address1: | 3721 HIGHWAY 412 E STE A | ||||||||
| Address2: | |||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727618010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792153035 | ||||||||
| FaxNumber: | 4795241818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E1104 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100181270A | 05 | OK | MEDICAID | 134149003 | 05 | AR | MEDICAID |