Healthcare Provider Details

I. General information

NPI: 1548395221
Provider Name (Legal Business Name): NORTH CENTRAL IV & RESPIRATORY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WASHINGTON AVE
JONESBORO AR
72401-3102
US

IV. Provider business mailing address

202 E WASHINGTON AVE
JONESBORO AR
72401-3102
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-0150
  • Fax: 870-932-0870
Mailing address:
  • Phone: 870-932-0150
  • Fax: 870-932-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberAR20511
License Number StateAR

VIII. Authorized Official

Name: VIOLA DARR
Title or Position: OWNER
Credential: RN
Phone: 870-932-0150