Healthcare Provider Details

I. General information

NPI: 1518156769
Provider Name (Legal Business Name): MCCRAY MEDICAL SUPPLIES & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 VILSONIA WAY
VILONIA AR
72173-9816
US

IV. Provider business mailing address

6 VILSONIA WAY
VILONIA AR
72173-9816
US

V. Phone/Fax

Practice location:
  • Phone: 501-605-6585
  • Fax:
Mailing address:
  • Phone: 501-605-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN STEVE MCCRAY
Title or Position: OWNER
Credential:
Phone: 501-605-6585