Provider Demographics
NPI:1225226988
Name:BROOKS MEDICAL OF MOUNTAIN HOME, INC.
Entity Type:Organization
Organization Name:BROOKS MEDICAL OF MOUNTAIN HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-424-9808
Mailing Address - Street 1:417 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4709
Mailing Address - Country:US
Mailing Address - Phone:870-424-9808
Mailing Address - Fax:870-424-9810
Practice Address - Street 1:417 E 9TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4709
Practice Address - Country:US
Practice Address - Phone:870-424-9808
Practice Address - Fax:870-424-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31275703001332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166731716Medicaid
6020830001Medicare NSC