Provider Demographics
NPI:1427139567
Name:TIPPIN SURGICAL SUPPLY
Entity type:Organization
Organization Name:TIPPIN SURGICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-489-5237
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:OLA
Mailing Address - State:AR
Mailing Address - Zip Code:72853-0249
Mailing Address - Country:US
Mailing Address - Phone:479-489-5237
Mailing Address - Fax:479-489-5714
Practice Address - Street 1:502 WEST PENNINGTON STREET
Practice Address - Street 2:
Practice Address - City:OLA
Practice Address - State:AR
Practice Address - Zip Code:72853
Practice Address - Country:US
Practice Address - Phone:479-489-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0339347500311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122975741Medicaid
AR4457960001Medicare NSC