| NPI | 1376558023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES DAVID HICKS General Mgr 501-932-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AR 124637716) |
| Additional Taxonomies | 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: AR 124637716) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2012-04-13 |