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General NPI Number Information
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NPI Number | 1083807986
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Entity Type | Organization
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Legal Business Name | VAMASSEY MEDICAL SUPPLY
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 214 N WASHINGTON AVE STE 303
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City | EL DORADO
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State | AR
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Zip | 71730-5644
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Country | US
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Telephone | 870-863-4009
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Fax | 870-863-4547
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Provider Business Mailing Address
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Address Line | PO BOX 10397
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City | EL DORADO
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State | AR
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Zip | 71730-0025
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Country | US
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Telephone | 870-863-4009
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Fax | 870-863-4547
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHANELL ELAINE MASSEY
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Credential |
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Telephone | 870-814-8707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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