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Organization

BRENDA D POLSTON

Active
Other names
THAT CERTAIN LOOK
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. BRENDA D POLSTON (OWNER)
(501) 729-5490
Entity
Organization

Contact information

Practice address
300 VAN BUREN, JUDSONIA, AR 72081-0297
(501) 729-5490
(501) 729-1511
Mailing address
PO BOX 297, 300 VAN BUREN, JUDSONIA, AR 72081-0297
(501) 729-5490
(501) 729-1511

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00440777
MS
05
141085716
AR
01
49701
BLUE CROSS BLUE SHIELD
AR
Enumeration date
05/08/2006
Last updated
07/10/2008
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