Organization
ACTIVE LIVING MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BILL BARNES PTA (COO)
(501) 379-9217
Entity
Organization
Contact information
Practice address
11324 ARCADE DR, SUITE 24, LITTLE ROCK, AR 72212-4074
(501) 379-9217
(501) 379-9218
Mailing address
11324 ARCADE DR, SUITE 24, LITTLE ROCK, AR 72212-4074
(501) 379-9217
(501) 379-9218
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
800124349
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167682716
—
AR
Enumeration date
01/10/2008
Last updated
06/05/2008
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