Healthcare Provider Details

I. General information

NPI: 1083807986
Provider Name (Legal Business Name): VAMASSEY MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N WASHINGTON AVE STE 303
EL DORADO AR
71730-5644
US

IV. Provider business mailing address

PO BOX 10397
EL DORADO AR
71730-0025
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-4009
  • Fax: 870-863-4547
Mailing address:
  • Phone: 870-863-4009
  • Fax: 870-863-4547

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: MS. SHANELL ELAINE MASSEY
Title or Position: OWNER
Credential:
Phone: 870-814-8707