Provider Demographics
NPI:1114131802
Name:PILLOW CLINIC, PLLC
Entity Type:Organization
Organization Name:PILLOW CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-572-5996
Mailing Address - Street 1:101 SHIRLEY HICKS DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-8852
Mailing Address - Country:US
Mailing Address - Phone:870-572-5996
Mailing Address - Fax:
Practice Address - Street 1:101 SHIRLEY HICKS DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8852
Practice Address - Country:US
Practice Address - Phone:870-572-5996
Practice Address - Fax:870-572-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152978002Medicaid