Organization
LIFETIME MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL ANTHONY CROWELL (PRESIDENT/CEO)
(870) 561-5433
Entity
Organization
Contact information
Practice address
623 A & B WEST STATE HIGHWAY 18, MANILA, AR 72442
(870) 561-5433
Mailing address
PO BOX 1324, MANILA, AR 72442-1324
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49821
BLUECROSS/BLUESHIELD
AR
Enumeration date
07/31/2006
Last updated
08/22/2020
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