Organization
MEDSOURCE DME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ERNEST STEVENSON IV (OWNER/PRESIDENT)
(870) 780-6111
Entity
Organization
Contact information
Practice address
615 W MOULTRIE DR, BLYTHEVILLE, AR 72315-1936
(870) 780-6111
(870) 762-0900
Mailing address
615 W MOULTRIE DR, BLYTHEVILLE, AR 72315-1936
(870) 780-6111
(870) 762-0900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
000614
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000614
AR BOARD OF PHARMACY
AR
Enumeration date
07/18/2006
Last updated
08/22/2020
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