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Organization
PRO-MED MEDICAL SUPPLY
Active
Organization
PRO-MED MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SLADE BROWN (OWNER)
(501) 353-2610
Entity
Organization
Contact information
Practice address
1313 N HILLS BLVD, SUITE 301, NORTH LITTLE ROCK, AR 72114-3757
(501) 353-2610
(501) 353-2621
Mailing address
1313 N HILLS BLVD, SUITE 301, NORTH LITTLE ROCK, AR 72114-3757
(501) 353-2610
(501) 353-2621
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
7573
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156282716
—
AR
01
—
49903
BLUE CROSS BLUE SHIELD
AR
Enumeration date
12/07/2006
Last updated
09/08/2008
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