Provider Demographics
NPI:1518052984
Name:MARK ALAN & KATHY JEANNE BRYANT DBA COLLEGE HILL MEDICAL AND HARDWARE
Entity Type:Organization
Organization Name:MARK ALAN & KATHY JEANNE BRYANT DBA COLLEGE HILL MEDICAL AND HARDWARE
Other - Org Name:COLLEGE HILL MEDICAL & HARDWARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-773-1878
Mailing Address - Street 1:3 COLLEGE HILL CENTER
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-6302
Mailing Address - Country:US
Mailing Address - Phone:870-773-1878
Mailing Address - Fax:870-773-0308
Practice Address - Street 1:3 COLLEGE HILL CENTER
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6302
Practice Address - Country:US
Practice Address - Phone:870-773-1878
Practice Address - Fax:870-773-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00216332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49570OtherAR BCBS PROVIDER #
AR49570OtherAR BCBS PROVIDER #
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