Provider Demographics
NPI:1023072808
Name:CHURCHILL, DAVID A
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 N NORTHHILLS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4007
Mailing Address - Country:US
Mailing Address - Phone:479-571-4338
Mailing Address - Fax:479-571-4015
Practice Address - Street 1:3211 N NORTHHILLS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4007
Practice Address - Country:US
Practice Address - Phone:479-571-4338
Practice Address - Fax:479-571-4015
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6809207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1670494OtherUNITED HEALTHCARE
AR122050000OtherQUALCHOICE
AR111127001Medicaid
AR4567131OtherAETNA
ARC6809OtherSTATE LICENSE
OK100077630AMedicaid
MO204813000Medicaid
ARA023OtherCHAMPUS
ARA023OtherCHAMPUS
AR122050000OtherQUALCHOICE
ARAC3145845OtherDEA
ARC67740Medicare UPIN