Provider Demographics
NPI:1225037401
Name:NATIONAL IV, INC.
Entity Type:Organization
Organization Name:NATIONAL IV, INC.
Other - Org Name:AMERICAN HOMEPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESDIENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-8191
Mailing Address - Street 1:PO BOX 676499
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6499
Mailing Address - Country:US
Mailing Address - Phone:501-537-2323
Mailing Address - Fax:501-671-6801
Practice Address - Street 1:5700 S ZERO ST
Practice Address - Street 2:STE. 2
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6505
Practice Address - Country:US
Practice Address - Phone:479-649-6464
Practice Address - Fax:479-649-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0420116333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0291700002Medicare ID - Type Unspecified