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
Update your record
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