Med South Medical Inc

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

License

31541360001 Issued in AR

Legal business name

MED SOUTH MEDICAL INC

Doing business as

Family Choice Nutrition

Practice address

6415 Witt LN Ste B
North Little Rock, AR 72118-2475

Phone

(501) 753-9393

Fax

(501) 753-9396

NPI assigned

Aug 31, 2006

Last updated

Jun 8, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Billie Graham

Title

President

Phone

(501) 753-9393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Choice Nutrition Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1194837229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 WITT LN STE B",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721182475",
            "telephone_number": "501-753-9393",
            "fax_number": "501-753-9396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6415 WITT LN STE B",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721182475",
            "telephone_number": "501-753-9393",
            "fax_number": "501-753-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED SOUTH MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-753-9393",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "AR",
            "license": "31541360001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163802716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Choice Nutrition",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Parenteral & Enteral Nutrition Supplies (DME) in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.