Provider Demographics
NPI:1104105972
Name:SHIPLEY & SILLS FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:SHIPLEY & SILLS FAMILY PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-242-2577
Mailing Address - Street 1:8101 MCCLURE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-6044
Mailing Address - Country:US
Mailing Address - Phone:792-422-5774
Mailing Address - Fax:479-434-5987
Practice Address - Street 1:8101 MCCLURE DR STE 203
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-6044
Practice Address - Country:US
Practice Address - Phone:479-242-2577
Practice Address - Fax:479-434-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty