Healthcare Provider Details

I. General information

NPI: 1982873626
Provider Name (Legal Business Name): ADVOCATE MEDICAL SUPPORT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CRESTWOOD CIR
MENA AR
71953-5515
US

IV. Provider business mailing address

300 CRESTWOOD CIR
MENA AR
71953-5515
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-1600
  • Fax: 479-394-1606
Mailing address:
  • Phone: 479-394-1600
  • Fax: 479-394-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JANET K VANDEEST
Title or Position: OWNER
Credential:
Phone: 479-394-1600