=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770182446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TPAB MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2020
-----------------------------------------------------
Last Update Date | 10/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 HONEY SUCKLE
-----------------------------------------------------
City | BROOKLAND
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72417-8980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-206-9920
-----------------------------------------------------
Fax | 870-206-9919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 483
-----------------------------------------------------
City | BROOKLAND
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72417-0483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-206-9920
-----------------------------------------------------
Fax | 870-206-9919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL BARKLEY
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 870-206-9920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------