Provider Demographics
NPI:1699707349
Name:MARY'S MEDICO RENTAL & SALES, INC.
Entity type:Organization
Organization Name:MARY'S MEDICO RENTAL & SALES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCNARY CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-337-4181
Mailing Address - Street 1:1023 E PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4363
Mailing Address - Country:US
Mailing Address - Phone:501-337-4181
Mailing Address - Fax:501-337-4636
Practice Address - Street 1:1023 E PAGE AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4363
Practice Address - Country:US
Practice Address - Phone:501-337-4181
Practice Address - Fax:501-337-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102639716Medicaid
ARP10001315478OtherAMBETTER OF ARKANSAS
AR1243853OtherWELLCARE
AR47813OtherBLUE CROSS BLUE SHIELD
AR0224120001Medicare ID - Type Unspecified