Provider Demographics
NPI:1316047194
Name:ARKANSAS HOME MEDICAL
Entity type:Organization
Organization Name:ARKANSAS HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-448-5984
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-0367
Mailing Address - Country:US
Mailing Address - Phone:870-448-5984
Mailing Address - Fax:870-448-3697
Practice Address - Street 1:3531 CENTRAL AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6280
Practice Address - Country:US
Practice Address - Phone:501-620-4553
Practice Address - Fax:501-620-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00777332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162262716Medicaid
AR162262716Medicaid