MEDICARE: CHARLES EDWARD PILLOW PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA155	AR

General Provider Information

NPI Number	:	1992758387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES EDWARD PILLOW PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1028
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-1028
Country	:	US
Telephone Number	:	501-882-5433
Fax Number	:	501-882-2512

Provider Business Practice Location Address
First Line	:	710-A DEWITT HENRY DRIVE
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012
Country	:	US
Telephone Number	:	501-882-5433
Fax Number	:	501-882-2512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/07/2023

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Directions to “ CHARLES EDWARD PILLOW PA-C” Practice Location

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