Provider Demographics
NPI:1417954207
Name:RICHARD C. PILLSBURY, MDPA
Entity Type:Organization
Organization Name:RICHARD C. PILLSBURY, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:PILLSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-863-0010
Mailing Address - Street 1:613 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4557
Practice Address - Country:US
Practice Address - Phone:870-863-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3001207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD08959Medicare UPIN
AR54081Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER