Provider Demographics
NPI:1013035179
Name:BROOKS MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:BROOKS MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-4597
Mailing Address - Street 1:800 JOE BROOKS DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4133
Mailing Address - Country:US
Mailing Address - Phone:870-932-4597
Mailing Address - Fax:870-932-0656
Practice Address - Street 1:800 JOE BROOKS DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4133
Practice Address - Country:US
Practice Address - Phone:870-932-4597
Practice Address - Fax:870-932-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121945716Medicaid
AR48452OtherARKANSAS BC BS
AR0406490001Medicare ID - Type Unspecified
AR121945716Medicaid