Provider Demographics
NPI:1407202724
Name:UPCHURCH HOLDINGS
Entity type:Organization
Organization Name:UPCHURCH HOLDINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-892-5433
Mailing Address - Street 1:3514 COUNTRY CLUB AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3300
Mailing Address - Country:US
Mailing Address - Phone:479-763-1085
Mailing Address - Fax:479-755-3567
Practice Address - Street 1:3514 COUNTRY CLUB AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3300
Practice Address - Country:US
Practice Address - Phone:479-763-1085
Practice Address - Fax:479-755-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies