Organization
MED SOUTH MEDICAL INC
Active
Other names
Family Choice Nutrition
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BILLIE GRAHAM (PRESIDENT)
(501) 753-9393
Entity
Organization
Contact information
Practice address
6415 WITT LN STE B, NORTH LITTLE ROCK, AR 72118-2475
(501) 753-9393
(501) 753-9396
Mailing address
6415 WITT LN STE B, NORTH LITTLE ROCK, AR 72118-2475
(501) 753-9393
(501) 753-9396
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
31541360001
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163802716
—
AR
Enumeration date
08/31/2006
Last updated
06/08/2010
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