Provider Demographics
NPI:1073748141
Name:RICHARD W. MILES, M.D. & ASSOC., PLLC
Entity Type:Organization
Organization Name:RICHARD W. MILES, M.D. & ASSOC., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-876-2736
Mailing Address - Street 1:PO BOX 3270
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-0270
Mailing Address - Country:US
Mailing Address - Phone:479-876-2736
Mailing Address - Fax:888-331-2737
Practice Address - Street 1:30 CAMBRIA DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-1503
Practice Address - Country:US
Practice Address - Phone:479-876-2736
Practice Address - Fax:888-331-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184232002Medicaid
AR184232002Medicaid