Provider Demographics
NPI:1588205132
Name:ARK MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ARK MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-877-7357
Mailing Address - Street 1:2400 SE VETERANS MEMORIAL PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4890
Mailing Address - Country:US
Mailing Address - Phone:772-877-3572
Mailing Address - Fax:
Practice Address - Street 1:2400 SE VETERANS MEMORIAL PKWY STE 210
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4890
Practice Address - Country:US
Practice Address - Phone:772-877-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies