Provider Demographics
NPI:1104896018
Name:CALHOUNS ARKANSAS MEDICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:CALHOUNS ARKANSAS MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-862-8841
Mailing Address - Street 1:201 WEST GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4646
Mailing Address - Country:US
Mailing Address - Phone:870-862-8841
Mailing Address - Fax:870-864-0218
Practice Address - Street 1:201 WEST GROVE STREET
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4646
Practice Address - Country:US
Practice Address - Phone:870-862-8841
Practice Address - Fax:870-864-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106116716Medicaid
AR48777OtherARKANSAS BLUE CROSS BS
AR48777OtherARKANSAS BLUE CROSS BS