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General NPI Number Information
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NPI Number | 1396750923
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Entity Type | Organization
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Legal Business Name | ROBERT GLEN ENTERPRISES INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 103 COUNTRY CLUB RD
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City | POCAHONTAS
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State | AR
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Zip | 72455-1364
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Country | US
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Telephone | 870-892-3037
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Fax | 870-892-9808
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Provider Business Mailing Address
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Address Line | PO BOX 345
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City | POCAHONTAS
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State | AR
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Zip | 72455-0345
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Country | US
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Telephone | 870-892-3037
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Fax | 870-892-9808
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Authorized Official
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Title or Position | VP
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Name | MR. JASON NIER
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Credential |
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Telephone | 870-892-3037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | MG00309
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License Number State | AR
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