MEDICARE: WESTERN ARKANSAS MEDICAL LLC

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	:	1457603433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN ARKANSAS MEDICAL LLC

Provider Business Mailing Address
First Line	:	3220 S 28TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-6904
Country	:	US
Telephone Number	:	479-221-6736
Fax Number	:	479-434-2145

Provider Business Practice Location Address
First Line	:	3220 S 28TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-6904
Country	:	US
Telephone Number	:	479-221-6736
Fax Number	:	479-434-2145

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WARREN JASON HURST
Credential	:
Telephone Number	:	479-221-6736

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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