Healthcare Provider Details

I. General information

NPI: 1669507018
Provider Name (Legal Business Name): ARKANSAS PROSTHETICS AND PEDORTHICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W CARPENTER ST
BENTON AR
72015-3317
US

IV. Provider business mailing address

119 W CARPENTER ST
BENTON AR
72015-3317
US

V. Phone/Fax

Practice location:
  • Phone: 501-860-6910
  • Fax: 501-860-7587
Mailing address:
  • Phone: 501-860-6910
  • Fax: 501-860-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL EDGAR JOHNSTON
Title or Position: OWNER
Credential: C.P., C-PED
Phone: 501-860-6910