MEDICARE: NATIONAL IV, INC.

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	333600000X	Pharmacy	0420116	AR

General Provider Information

NPI Number	:	1225037401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL IV, INC.

Provider Business Mailing Address
First Line	:	PO BOX 676499
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-6499
Country	:	US
Telephone Number	:	501-537-2323
Fax Number	:	501-671-6801

Provider Business Practice Location Address
First Line	:	5700 S ZERO ST
Second Line	:	STE. 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6505
Country	:	US
Telephone Number	:	479-649-6464
Fax Number	:	479-649-6565

Authorized Official
Title or Position	:	SR. VICE PRESDIENT
Name	:	MR. JOHN D. GOUY
Credential	:
Telephone Number	:	615-221-8191

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/22/2020

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