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NPI Code Detail

MEDICARE: SPARKS MEDICAL FOUNDATION

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
1332B00000XDurable Medical Equipment & Medical SuppliesAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14454530005OTHERARM-CAE DME

General Provider Information

NPI Number : 1669576237
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 : 4700 KELLEY HWY
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-5024
Country : US
Telephone Number : 479-573-7970
Fax Number : 479-573-7971
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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