Provider Demographics
NPI:1588385876
Name:IHC SUPPLY, INC.
Entity type:Organization
Organization Name:IHC SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BRAZIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-623-4422
Mailing Address - Street 1:3911 CENTRAL AVENUE
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7210
Mailing Address - Country:US
Mailing Address - Phone:501-623-4422
Mailing Address - Fax:
Practice Address - Street 1:3911 CENTRAL AVE STE H3911
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7210
Practice Address - Country:US
Practice Address - Phone:501-623-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies