Provider Demographics
NPI:1063819969
Name:SILOAM SPRINGS WOMENS CLINIC WOMENS CENTER
Entity Type:Organization
Organization Name:SILOAM SPRINGS WOMENS CLINIC WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-524-9312
Mailing Address - Street 1:603-2 N PROGRESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4113
Mailing Address - Country:US
Mailing Address - Phone:479-524-9312
Mailing Address - Fax:479-524-9627
Practice Address - Street 1:603-2 N PROGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4113
Practice Address - Country:US
Practice Address - Phone:479-524-9312
Practice Address - Fax:479-524-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1063819969OtherNPI