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General NPI Number Information
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NPI Number | 1639435464
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Entity Type | Organization
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Legal Business Name | FAITH MEDICAL INCORPORATED
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 1360 S CONSTITUTION AVE
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City | ASHDOWN
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State | AR
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Zip | 71822-8652
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Country | US
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Telephone | 870-898-3838
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Fax | 870-898-3946
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Provider Business Mailing Address
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Address Line | 420 BRODIE LN
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City | ASHDOWN
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State | AR
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Zip | 71822-9606
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Country | US
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Telephone | 903-276-6162
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL PENNINGTON
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Credential |
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Telephone | 903-276-6162
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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 |
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License Number State |
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