Provider Demographics
NPI:1891987616
Name:ACTION MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:ACTION MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNI
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-358-2484
Mailing Address - Street 1:109 HIGHWAY 463 S
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-2604
Mailing Address - Country:US
Mailing Address - Phone:870-483-6959
Mailing Address - Fax:
Practice Address - Street 1:109 HIGHWAY 463 S
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-2604
Practice Address - Country:US
Practice Address - Phone:870-483-6959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROACH ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00006332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6023660001Medicare NSC