Healthcare Provider Details

I. General information

NPI: 1912975749
Provider Name (Legal Business Name): COMPREHENSIVE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 W BROADWAY ST
WEST MEMPHIS AR
72301-2907
US

IV. Provider business mailing address

648 W BROADWAY ST
WEST MEMPHIS AR
72301-2907
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-1010
  • Fax: 870-733-1011
Mailing address:
  • Phone: 870-733-1010
  • Fax: 870-733-1011

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 NumberMG00601
License Number StateAR

VIII. Authorized Official

Name: MR. ROBERT DOUGLAS BLAKE II
Title or Position: OWNER
Credential:
Phone: 870-733-1010