Provider Demographics
NPI:1457603433
Name:WESTERN ARKANSAS MEDICAL LLC
Entity Type:Organization
Organization Name:WESTERN ARKANSAS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-221-6736
Mailing Address - Street 1:3220 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6904
Mailing Address - Country:US
Mailing Address - Phone:479-221-6736
Mailing Address - Fax:479-434-2145
Practice Address - Street 1:3220 S 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6904
Practice Address - Country:US
Practice Address - Phone:479-221-6736
Practice Address - Fax:479-434-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies