MEDICARE: FORT SMITH SURGICAL SUPPLY CO

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1104049022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT SMITH SURGICAL SUPPLY CO

Provider Business Mailing Address
First Line	:	809 S Y ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5917
Country	:	US
Telephone Number	:	479-783-8929
Fax Number	:	479-783-8920

Provider Business Practice Location Address
First Line	:	809 S Y ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5917
Country	:	US
Telephone Number	:	479-783-8929
Fax Number	:	479-783-8920

Authorized Official
Title or Position	:	BOOKKEEPER
Name	:	MS. DEBI CARROLL
Credential	:
Telephone Number	:	479-783-8929

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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