Organization
WILD MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN WILD (C.E.O.)
(501) 613-4724
Entity
Organization
Contact information
Practice address
2821 KAVANAUGH BLVD STE 1C, LITTLE ROCK, AR 72205-3868
(501) 235-8978
(501) 325-3059
Mailing address
2821 KAVANAUGH BLVD STE 1C, LITTLE ROCK, AR 72205-3868
(501) 235-8978
(501) 325-3059
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MG00958
AR
Other
Enumeration date
06/02/2009
Last updated
07/19/2010
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