Organization
FOSSIL MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN C BALENKO (PRESIDENT)
(501) 286-6019
Entity
Organization
Contact information
Practice address
2800 SOUTH 2ND STREET, SUITE D, CABOT, AR 72023-7025
(501) 286-6019
(501) 286-6021
Mailing address
2800 SOUTH 2ND STREET, SUITE D, CABOT, AR 72023-7025
(501) 286-6019
(501) 286-6021
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/10/2015
Last updated
02/10/2015
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