Organization
MIDSTATE MED-CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES DAVID HICKS (GENERAL MGR)
(501) 932-0033
Entity
Organization
Contact information
Practice address
800 EXCHANGE AVE, SUITE 104, CONWAY, AR 72032-7833
(501) 932-3180
(501) 932-0261
Mailing address
PO BOX 781, CONWAY, AR 72033-0781
(501) 932-3180
(501) 932-0261
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
124637716
AR
332BN1400X
Nursing Facility Supplies (DME)
124637716
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124637716
—
AR
Enumeration date
07/30/2006
Last updated
04/13/2012
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