Provider Demographics
NPI:1700896925
Name:ACTION MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ACTION MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-483-6959
Mailing Address - Street 1:1400 HIGHWAY 69 BLVD
Mailing Address - Street 2:PO BOX 14
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-2147
Mailing Address - Country:US
Mailing Address - Phone:870-483-6959
Mailing Address - Fax:870-483-7228
Practice Address - Street 1:109 HIGHWAY 463 S
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-2604
Practice Address - Country:US
Practice Address - Phone:870-483-6959
Practice Address - Fax:870-483-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR000607332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR48992OtherBC/BS PROVIDER NUMBER
AR0930110001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER