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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID HOLMES (OWNER)
(870) 933-6296
Entity
Organization

Contact information

Practice address
2308 SUNNY MEADOW DR, JONESBORO, AR 72404-9348
(870) 933-6296
(870) 933-6286
Mailing address
PO BOX 16926, JONESBORO, AR 72403-6716
(870) 933-6296
(870) 933-6286

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
160510716
AR
01
49667
ARKANSAS BLUE CROSS
AR
05
626152706
MO
Enumeration date
06/24/2006
Last updated
02/07/2013
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