Organization
MED SOUTH MEDICAL INC
Active
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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