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General NPI Number Information
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NPI Number | 1467639096
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Entity Type | Organization
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Legal Business Name | UNIVERSAL MEDICAL SUPPLY CORP
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | 801 S BOWMAN RD SUITE 2
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3433
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Country | US
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Telephone | 479-936-8484
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Fax | 479-936-8222
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Provider Business Mailing Address
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Address Line | 726 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-3760
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Country | US
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Telephone | 479-936-8484
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Fax | 479-936-8222
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Authorized Official
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Title or Position | OWNER
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Name | MR. JERRY DEAN COOK
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Credential | BA, CEAC, ATS
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Telephone | 479-936-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | MG00161
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License Number State | AR
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