Provider Demographics
NPI:1083807986
Name:VAMASSEY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:VAMASSEY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANELL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-814-8707
Mailing Address - Street 1:PO BOX 10397
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-0025
Mailing Address - Country:US
Mailing Address - Phone:870-863-4009
Mailing Address - Fax:870-863-4547
Practice Address - Street 1:214 N WASHINGTON AVE STE 303
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5644
Practice Address - Country:US
Practice Address - Phone:870-863-4009
Practice Address - Fax:870-863-4547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAMASSEY MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies