Provider Demographics
NPI:1639111347
Name:NEWPORT HOSPITAL DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:NEWPORT HOSPITAL DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRANKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-523-5879
Mailing Address - Street 1:557 JOHNNY CASH BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2687
Mailing Address - Country:US
Mailing Address - Phone:615-824-8823
Mailing Address - Fax:615-824-6175
Practice Address - Street 1:2000 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3661
Practice Address - Country:US
Practice Address - Phone:870-523-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARG00311332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0403450002Medicare ID - Type Unspecified
AR0403450003Medicare ID - Type Unspecified