1003024787 NPI number — CENRTAL MEDICAL SUPPLY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003024787 NPI number — CENRTAL MEDICAL SUPPLY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENRTAL MEDICAL SUPPLY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003024787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 JOHN BARROW RD
Provider Second Line Business Mailing Address:
# 304
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-6500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-224-7744
Provider Business Mailing Address Fax Number:
501-224-7748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 JOHN BARROW RD
Provider Second Line Business Practice Location Address:
# 304
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-224-7744
Provider Business Practice Location Address Fax Number:
501-224-7748
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLETCHER
Authorized Official First Name:
ELI
Authorized Official Middle Name:
TERRY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-224-7744

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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