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General NPI Number Information
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NPI Number | 1912182445
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Entity Type | Organization
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Legal Business Name | PRO-MED OF THE JONESBORO, INC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 2379 HIGHWAY 62 412 SUITE L
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City | HIGHLAND
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State | AR
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Zip | 72542-9393
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Country | US
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Telephone | 870-856-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 300 CARSON ST SUITE 103
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City | JONESBORO
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State | AR
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Zip | 72401-3104
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Country | US
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Telephone | 870-931-9565
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREG BROOKS
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Credential |
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Telephone | 870-931-0022
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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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