Organization
PTCOA HOME INFUSION SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERAJ SIDDIQUI MD (OWNER)
(501) 712-2571
Entity
Organization
Contact information
Practice address
108 N SHACKLEFORD RD, LITTLE ROCK, AR 72211-2840
(844) 215-0731
(501) 404-7789
Mailing address
108 N SHACKLEFORD RD, LITTLE ROCK, AR 72211-2840
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MG01994
SUPPLIER MEDICAL EQUIPMENT LICENSE
AR
Enumeration date
03/01/2021
Last updated
03/01/2021
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