Provider Demographics
NPI:1063644987
Name:HILL, LUKE
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2720
Mailing Address - Country:US
Mailing Address - Phone:479-750-7778
Mailing Address - Fax:
Practice Address - Street 1:986 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2720
Practice Address - Country:US
Practice Address - Phone:479-750-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0-T0941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR906127321Medicaid