Provider Demographics
NPI:1407935349
Name:TEAM MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:TEAM MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-854-8326
Mailing Address - Street 1:210 N. STATE LINE AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5917
Mailing Address - Country:US
Mailing Address - Phone:870-773-0250
Mailing Address - Fax:870-773-0272
Practice Address - Street 1:210 N. STATE LINE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5917
Practice Address - Country:US
Practice Address - Phone:870-773-0250
Practice Address - Fax:870-773-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5706780001Medicare NSC
AR160815716Medicaid