| Richard T Pruiksma, MD | |
|
500 S Mount Olive St, Suite 200, Siloam Springs, AR 72761-3602 | |
| (479) 524-9550 | |
| (479) 524-9552 |
| Full Name | Richard T Pruiksma |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 500 S Mount Olive St, Siloam Springs, Arkansas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053357491 | NPI | - | NPPES |
| 351793 | Other | AR | MEDICARE ID |
| E-0221 | Other | AR | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20107 (Oklahoma) | Secondary |
| 207Q00000X | Family Medicine | 04-28209 (Kansas) | Secondary |
| 207Q00000X | Family Medicine | E-0221 (Arkansas) | Primary |
| Entity Name | Su Clinica Familiar |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285643304 PECOS PAC ID: 5496663429 Enrollment ID: O20040121001155 |
| Mailing Address | Practice Location Address |
|---|---|
| Richard T Pruiksma, MD 614 E Emma Avenue, Suite 300, Springdale, AR 72764-4469 Ph: (479) 751-7417 | Richard T Pruiksma, MD 500 S Mount Olive St, Suite 200, Siloam Springs, AR 72761-3602 Ph: (479) 524-9550 |
Dr. George H Benjamin, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 451 S Holly St, Siloam Springs, AR 72761 Phone: 479-524-3141 Fax: 479-549-4601 | |
Dr. Scott G Stinnett, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 451 S Holly St, Siloam Springs, AR 72761 Phone: 479-524-3141 Fax: 479-524-3090 | |
Lori Lynn Douglas, Family Medicine Medicare: Medicare Enrolled Practice Location: 3721 Highway 412 E Ste B, Siloam Springs, AR 72761 Phone: 479-215-3080 | |
Dr. Roger W Youmans, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 451 S Holly St, Siloam Springs, AR 72761 Phone: 479-524-3141 Fax: 479-524-3090 | |
Dr. Steven Johnson, D.O. Family Medicine Medicare: Medicare Enrolled Practice Location: 13331 Fairway Ct, Siloam Springs, AR 72761 Phone: 479-238-1222 Fax: 479-238-1229 | |
Jennifer Cheatham, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1700-1 East Quarter Rd., Siloam Springs, AR 72761 Phone: 479-238-1229 |