Organization
MALLARD MEDICAL SUPPLY LLC
Active
Other names
Mallard Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY K WARDLAW (MEMBER)
(870) 460-2814
Entity
Organization
Contact information
Practice address
801 E CHURCH ST, WARREN, AR 71671-3454
(870) 226-9501
(870) 226-9500
Mailing address
801 E CHURCH ST, WARREN, AR 71671-3454
(870) 226-9501
(870) 226-9500
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
14306
AR
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
09/26/2013
Last updated
01/17/2014
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