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General NPI Number Information
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NPI Number | 1780860643
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Entity Type | Organization
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Legal Business Name | ACTIVE LIVING MEDICAL SUPPLY
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 11324 ARCADE DR SUITE 24
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City | LITTLE ROCK
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State | AR
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Zip | 72212-4074
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Country | US
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Telephone | 501-379-9217
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Fax | 501-379-9218
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Provider Business Mailing Address
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Address Line | 11324 ARCADE DR SUITE 24
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City | LITTLE ROCK
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State | AR
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Zip | 72212-4074
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Country | US
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Telephone | 501-379-9217
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Fax | 501-379-9218
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Authorized Official
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Title or Position | COO
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Name | MR. BILL BARNES
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Credential | PTA
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Telephone | 501-379-9217
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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 | 800124349
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License Number State | AR
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