Provider Demographics
NPI:1073546800
Name:SUPER RX MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SUPER RX MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-495-7700
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72833-1659
Mailing Address - Country:US
Mailing Address - Phone:479-495-7700
Mailing Address - Fax:479-495-2646
Practice Address - Street 1:304 EAST 8TH STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833-1659
Practice Address - Country:US
Practice Address - Phone:479-495-7700
Practice Address - Fax:479-495-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00461332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47350OtherBLUE CROSS PROVIDER NUMBE
AR47350OtherBLUE CROSS PROVIDER NUMBE