Healthcare Provider Details

I. General information

NPI: 1356321673
Provider Name (Legal Business Name): CAMDEN MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 HWY 271 S SUITE C
FORT SMITH AR
72908-8863
US

IV. Provider business mailing address

PO BOX 27968
SALT LAKE CITY UT
84127-0968
US

V. Phone/Fax

Practice location:
  • Phone: 479-646-0001
  • Fax: 479-646-5671
Mailing address:
  • Phone: 407-246-1226
  • Fax: 407-648-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBIN L MENCHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 407-822-4600