=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053305078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O'BRIAN HEALTHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2005
-----------------------------------------------------
Last Update Date | 02/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 PIPER ST STE G
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-8263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-321-9462
-----------------------------------------------------
Fax | 501-321-9552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 PIPER ST STE G
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-8263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-321-9462
-----------------------------------------------------
Fax | 501-321-9552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DOUG O GREEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-321-9461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | MG00362
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------