Provider Demographics
NPI:1689966962
Name:EASTERN ARKANSAS DIABETIC AND MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EASTERN ARKANSAS DIABETIC AND MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-816-5363
Mailing Address - Street 1:511 EAST PLAZA
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2535
Mailing Address - Country:US
Mailing Address - Phone:870-572-9335
Mailing Address - Fax:
Practice Address - Street 1:511 PLAZA
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2512
Practice Address - Country:US
Practice Address - Phone:870-572-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies