Healthcare Provider Details

I. General information

NPI: 1831112614
Provider Name (Legal Business Name): ORTHOSOURCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830B E ROBINSON AVE
SPRINGDALE AR
72764-7113
US

IV. Provider business mailing address

PO BOX 7510
SPRINGDALE AR
72766-7510
US

V. Phone/Fax

Practice location:
  • Phone: 479-872-1885
  • Fax: 479-872-1889
Mailing address:
  • Phone: 479-872-1885
  • Fax: 479-872-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number011957
License Number StateAR

VIII. Authorized Official

Name: MR. JAMES HAL DEJARNATT
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 479-872-1885