Healthcare Provider Details

I. General information

NPI: 1225226988
Provider Name (Legal Business Name): BROOKS MEDICAL OF MOUNTAIN HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E 9TH ST
MOUNTAIN HOME AR
72653-4709
US

IV. Provider business mailing address

417 E 9TH ST
MOUNTAIN HOME AR
72653-4709
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-9808
  • Fax: 870-424-9810
Mailing address:
  • Phone: 870-424-9808
  • Fax: 870-424-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number31275703001
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RHONDA FLOWERS
Title or Position: PRESIDENT
Credential:
Phone: 870-424-9808