Healthcare Provider Details

I. General information

NPI: 1447387014
Provider Name (Legal Business Name): SOUTHWEST ARKANSAS FURNITURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N MAIN ST
NASHVILLE AR
71852-2004
US

IV. Provider business mailing address

PO BOX 66
NASHVILLE AR
71852-0066
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-3767
  • Fax: 870-845-1100
Mailing address:
  • Phone: 870-845-3767
  • Fax: 870-845-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MARCUS RAY BLAKELY
Title or Position: OWNER
Credential:
Phone: 870-845-3767