Provider Demographics
NPI:1407170897
Name:ANAYA MEDICAL, INC
Entity Type:Organization
Organization Name:ANAYA MEDICAL, INC
Other - Org Name:ANAYA MEDICAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC,LGAT,CFTS
Authorized Official - Phone:870-875-2200
Mailing Address - Street 1:PO BOX 10505
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-0003
Mailing Address - Country:US
Mailing Address - Phone:870-875-2200
Mailing Address - Fax:870-875-2203
Practice Address - Street 1:610 N FLENNIKEN AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4523
Practice Address - Country:US
Practice Address - Phone:870-875-2200
Practice Address - Fax:870-875-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG01021332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6275270002Medicare NSC