Healthcare Provider Details

I. General information

NPI: 1982768214
Provider Name (Legal Business Name): STONE COUNTY MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WEST MAIN
MOUNTAIN VIEW AR
72560-1938
US

IV. Provider business mailing address

PO BOX 1938
MOUNTAIN VIEW AR
72560-1938
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-2583
  • Fax: 870-269-5357
Mailing address:
  • Phone: 870-269-2583
  • Fax: 870-269-5357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG00284
License Number StateAR

VIII. Authorized Official

Name: MR. JULIUS R HENDERSON
Title or Position: MANAGER
Credential:
Phone: 870-269-2583