Healthcare Provider Details

I. General information

NPI: 1518996487
Provider Name (Legal Business Name): ARKANSAS HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 EAST NOME ST
MARSHALL AR
72650
US

IV. Provider business mailing address

PO BOX 367
MARSHALL AR
72650-0367
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-5984
  • Fax: 870-448-3697
Mailing address:
  • Phone: 870-448-5984
  • Fax: 870-448-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG00478
License Number StateAR

VIII. Authorized Official

Name: JEREMY O RIDDLE
Title or Position: OWNER
Credential: MSPT
Phone: 870-448-5984