Provider Demographics
NPI:1609035823
Name:JUBAR LLC
Entity Type:Organization
Organization Name:JUBAR LLC
Other - Org Name:NEW BALANCE LITTLE ROCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:D
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:501-794-1356
Mailing Address - Street 1:19718 INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8023
Mailing Address - Country:US
Mailing Address - Phone:501-794-1356
Mailing Address - Fax:501-794-1356
Practice Address - Street 1:13900 CANTRELL RD STE 1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1516
Practice Address - Country:US
Practice Address - Phone:501-224-8877
Practice Address - Fax:501-794-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5967010002Medicare NSC