Organization
STATEWIDE MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MARK HICKMAN (OWNER)
(501) 834-1887
Entity
Organization
Contact information
Practice address
6100 GETTY DR, STE U, NORTH LITTLE ROCK, AR 72117-1635
(501) 834-1887
(501) 834-1866
Mailing address
PO BOX 7246, SHERWOOD, AR 72124
(501) 834-1887
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
10724
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167086716
—
AR
Enumeration date
11/27/2007
Last updated
06/09/2008
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