Provider Demographics
NPI:1104049022
Name:FORT SMITH SURGICAL SUPPLY CO
Entity type:Organization
Organization Name:FORT SMITH SURGICAL SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-8929
Mailing Address - Street 1:809 S Y ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5917
Mailing Address - Country:US
Mailing Address - Phone:479-783-8929
Mailing Address - Fax:479-783-8920
Practice Address - Street 1:809 S Y ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5917
Practice Address - Country:US
Practice Address - Phone:479-783-8929
Practice Address - Fax:479-783-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0294940001Medicare ID - Type Unspecified