MEDICARE: DTR MEDICAL, 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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609872142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DTR MEDICAL, INC

Provider Business Mailing Address
First Line	:	122 S 1ST ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4502
Country	:	US
Telephone Number	:	479-936-7050
Fax Number	:	479-936-7080

Provider Business Practice Location Address
First Line	:	122 S 1ST ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4502
Country	:	US
Telephone Number	:	479-936-7050
Fax Number	:	479-936-7080

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JEFF S LITTLE
Credential	:
Telephone Number	:	479-936-7050

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/10/2023

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Directions to “DTR MEDICAL, INC ” Practice Location

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