MEDICARE: PRO-MED MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	7573	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49903	OTHER	AR	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023177813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-MED MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	1313 N HILLS BLVD
Second Line	:	SUITE 301
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-3757
Country	:	US
Telephone Number	:	501-353-2610
Fax Number	:	501-353-2621

Provider Business Practice Location Address
First Line	:	1313 N HILLS BLVD
Second Line	:	SUITE 301
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-3757
Country	:	US
Telephone Number	:	501-353-2610
Fax Number	:	501-353-2621

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SLADE BROWN
Credential	:
Telephone Number	:	501-353-2610

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	09/08/2008

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Directions to “PRO-MED MEDICAL SUPPLY ” Practice Location

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