Healthcare Provider Details

I. General information

NPI: 1700404142
Provider Name (Legal Business Name): CUFFIE HEALTHCARE ON WHEELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 INGRAM BLVD
WEST MEMPHIS AR
72301-3403
US

IV. Provider business mailing address

403 INGRAM BLVD
WEST MEMPHIS AR
72301-3403
US

V. Phone/Fax

Practice location:
  • Phone: 870-394-4600
  • Fax: 870-533-5564
Mailing address:
  • Phone: 870-394-4600
  • Fax: 870-533-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. A LISA L CUFFIE
Title or Position: CEO
Credential:
Phone: 870-394-4600