Healthcare Provider Details

I. General information

NPI: 1235182387
Provider Name (Legal Business Name): NORTHEAST ARKANSAS SERVICE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 W MAIN ST
WALNUT RIDGE AR
72476-1430
US

IV. Provider business mailing address

PO BOX 839
WALNUT RIDGE AR
72476-0839
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-1260
  • Fax: 870-886-7525
Mailing address:
  • Phone: 870-886-1260
  • Fax: 870-886-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUNOIR L BRINER
Title or Position: VP OF SUPPORT
Credential:
Phone: 870-886-1260