Provider Demographics
NPI:1851548689
Name:SILOAM SPRINGS INTERNAL MEDICINE CLINIC, PLLC
Entity Type:Organization
Organization Name:SILOAM SPRINGS INTERNAL MEDICINE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:479-549-4010
Mailing Address - Street 1:1101 N. PROGRESS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3602
Mailing Address - Country:US
Mailing Address - Phone:479-549-4010
Mailing Address - Fax:479-549-3302
Practice Address - Street 1:1101 N PROGRESS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4343
Practice Address - Country:US
Practice Address - Phone:479-549-4010
Practice Address - Fax:479-549-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty