Provider Demographics
NPI:1871819474
Name:AIRWAYS MEDICAL LLC
Entity Type:Organization
Organization Name:AIRWAYS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:501-954-9922
Mailing Address - Street 1:9303 TREASURE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-6217
Mailing Address - Country:US
Mailing Address - Phone:501-954-9922
Mailing Address - Fax:501-954-8308
Practice Address - Street 1:1112 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9157
Practice Address - Country:US
Practice Address - Phone:479-705-9401
Practice Address - Fax:479-705-8801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIRWAYS MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165873716Medicaid
5999260001Medicare NSC