Healthcare Provider Details

I. General information

NPI: 1861782385
Provider Name (Legal Business Name): 1ST MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 MARKET ST SUITE 7A
DOVER AR
72837-9110
US

IV. Provider business mailing address

PO BOX 10215
RUSSELLVILLE AR
72812-0215
US

V. Phone/Fax

Practice location:
  • Phone: 501-860-3500
  • Fax: 800-661-8025
Mailing address:
  • Phone:
  • Fax:

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: SANDRA NORTHERN
Title or Position: PRESIDENT
Credential:
Phone: 501-860-3500