# FORT SMITH DIALYSIS SUPPLY COMPANY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518962760
- **Authorized official:** MRS. PAMELA SUE CLARK RN,CNN (DIRECTOR)
- **Authorized official phone:** (479) 709-6828

## Contact information

- **Practice address:** 1506 DODSON AVE, FORT SMITH, AR 72901-5128
- **Practice address phone:** (479) 709-6828
- **Practice address fax:** (479) 709-7453
- **Mailing address:** 1506 DODSON AVE, FORT SMITH, AR 72901-5128
- **Mailing address phone:** (479) 709-6828
- **Mailing address fax:** (479) 709-7453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BD1200X | Dialysis Equipment & Supplies (DME) | — | NULL | Yes |

## Other

- **Enumeration date:** 06/15/2005
- **Last updated:** 08/22/2020