Provider Demographics
NPI:1518284363
Name:PAUL W. ILES INC.
Entity Type:Organization
Organization Name:PAUL W. ILES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ILES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSY D
Authorized Official - Phone:417-881-1580
Mailing Address - Street 1:2200 E SUNSHINE ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1819
Mailing Address - Country:US
Mailing Address - Phone:417-881-1580
Mailing Address - Fax:417-881-7004
Practice Address - Street 1:2200 E SUNSHINE ST
Practice Address - Street 2:SUITE 312
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1819
Practice Address - Country:US
Practice Address - Phone:417-881-1580
Practice Address - Fax:417-881-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140683261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122501848Medicaid
MO122501848OtherMEDICARE