MEDICARE: SPARKS MEDICAL FOUNDATION

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		AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4454530051	OTHER	AR	M-CARE DME

General Provider Information

NPI Number	:	1447354014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARKS MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 2420
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72902-2420
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	17 S. LOGAN ST.
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933
Country	:	US
Telephone Number	:	479-965-7702
Fax Number	:	479-965-2180

Authorized Official
Title or Position	:	CBO SUPPORT MANAGER
Name	:	REBECCA COX
Credential	:
Telephone Number	:	479-709-7057

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/22/2020

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Directions to “SPARKS MEDICAL FOUNDATION ” Practice Location

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