1073748141 NPI number — RICHARD W. MILES, M.D. & ASSOC., PLLC

Table of content: (NPI 1073748141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073748141 NPI number — RICHARD W. MILES, M.D. & ASSOC., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD W. MILES, M.D. & ASSOC., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073748141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLA VISTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72715-0270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-876-2736
Provider Business Mailing Address Fax Number:
888-331-2737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CAMBRIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLA VISTA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72715-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-876-2736
Provider Business Practice Location Address Fax Number:
888-331-2737
Provider Enumeration Date:
05/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MILES
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PHYSICIAN / OWNER
Authorized Official Telephone Number:
479-876-2736

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 184232002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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