Basic Information
| Provider Information | |||||||||
| NPI: | 1851548689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SILOAM SPRINGS INTERNAL MEDICINE CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 N. PROGRESS AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727613602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795494010 | ||||||||
| FaxNumber: | 4795493302 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 N PROGRESS AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727614343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795494010 | ||||||||
| FaxNumber: | 4795493302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 12/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | MEEHAN | ||||||||
| AuthorizedOfficialFirstName: | RALPH | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4795494010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.