Healthcare Provider Details

I. General information

NPI: 1982911798
Provider Name (Legal Business Name): SELECT MEDICAL SUPPLIES OF ARKANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SOUTHPARK SHOPPING CTR
NASHVILLE AR
71852-3307
US

IV. Provider business mailing address

24 SOUTHPARK SHOPPING CTR
NASHVILLE AR
71852-3307
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-3813
  • Fax: 870-845-3808
Mailing address:
  • Phone: 870-845-3813
  • Fax: 870-845-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG01007
License Number StateAR

VIII. Authorized Official

Name: OLGA WESSON
Title or Position: PRESIDENT
Credential:
Phone: 917-562-8007