Provider Demographics
NPI:1942369327
Name:ARKANSAS RESPIRATORY AND EQUIPMENT PROVIDERS
Entity Type:Organization
Organization Name:ARKANSAS RESPIRATORY AND EQUIPMENT PROVIDERS
Other - Org Name:PEDIATRIC NUTRITIONAL PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNICK
Authorized Official - Suffix:
Authorized Official - Credentials:CRTLRCP
Authorized Official - Phone:501-318-1110
Mailing Address - Street 1:3632 CENTRAL AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6403
Mailing Address - Country:US
Mailing Address - Phone:501-318-1110
Mailing Address - Fax:501-318-1118
Practice Address - Street 1:3632 CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6403
Practice Address - Country:US
Practice Address - Phone:501-318-1110
Practice Address - Fax:501-318-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR253101-62-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4673130002Medicare NSC