Provider Demographics
NPI:1912975749
Name:COMPREHENSIVE MEDICAL LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:870-733-1010
Mailing Address - Street 1:648 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2907
Mailing Address - Country:US
Mailing Address - Phone:870-733-1010
Mailing Address - Fax:870-733-1011
Practice Address - Street 1:648 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2907
Practice Address - Country:US
Practice Address - Phone:870-733-1010
Practice Address - Fax:870-733-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ARMG00601332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1322707OtherBCBSTN
AR49892OtherBCBS
AR5110300001Medicare NSC