Provider Demographics
NPI:1235182387
Name:NORTHEAST ARKANSAS SERVICE COMPANY
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS SERVICE COMPANY
Other - Org Name:HOME MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JUNOIR
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-886-1260
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0839
Mailing Address - Country:US
Mailing Address - Phone:870-886-1260
Mailing Address - Fax:870-886-7525
Practice Address - Street 1:1315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1430
Practice Address - Country:US
Practice Address - Phone:870-886-1260
Practice Address - Fax:870-886-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139900716Medicaid
AR48842OtherBLUE CROSS
AR48842OtherBLUE CROSS