MEDICARE: QUALITY RESPIRATORY CARE INC

Medicare Provider Information

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	05764	MS
2	332B00000X	Durable Medical Equipment & Medical Supplies	MG00103	AR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	49267	OTHER	AR	AR BCBS PROVIDER ID

NPI Number	:	1215015615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY RESPIRATORY CARE INC

Provider Business Mailing Address
First Line	:	1239 W HIGHWAY 49
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-1716
Country	:	US
Telephone Number	:	870-572-1000
Fax Number	:	870-572-1026

Provider Business Practice Location Address
First Line	:	1239 W HIGHWAY 49
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-1716
Country	:	US
Telephone Number	:	870-572-1000
Fax Number	:	870-572-1026

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. NELSON AINSWORTH
Credential	:
Telephone Number	:	870-572-1000

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/20/2019

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308