Organization
SPARKS MEDICAL FOUNDATIN
Active
Other names
Waldron Place Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA COX (CBO SUPPORT MANAGER)
(479) 709-7057
Entity
Organization
Contact information
Practice address
1501 S WALDRON RD, STE 100, FORT SMITH, AR 72903-2574
(479) 709-7310
(479) 709-7315
Mailing address
PO BOX 2420, FORT SMITH, AR 72902-2420
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4454530012
M-CARE DME
AR
Enumeration date
09/14/2006
Last updated
08/22/2020
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