Provider Demographics
NPI:1942787551
Name:DILL MD LTD LLC
Entity Type:Organization
Organization Name:DILL MD LTD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DOYNE
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-541-8701
Mailing Address - Street 1:6671 GAP POINT CIR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4052
Mailing Address - Country:US
Mailing Address - Phone:501-771-4693
Mailing Address - Fax:
Practice Address - Street 1:6810 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7828
Practice Address - Country:US
Practice Address - Phone:501-771-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty