NPIMap

Organization Active NPI

Professional Drivers Medical Depots

  • Clinic/Center
  • West Memphis, AR
National Provider Identifier
1205038585
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROFESSIONAL DRIVERS MEDICAL DEPOTS
Practice address
3902 Petro Road
I-40, Exit 280
West Memphis, AR 72301
Phone
(615) 661-8929
Fax
(615) 661-8977
NPI assigned
May 31, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Colleen Adams
Title
Billing Manager
Phone
(615) 661-8929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X AR Primary

Addresses

Primary practice location

3902 Petro Road
I-40, Exit 280
West Memphis, AR 72301

Mailing address

3902 Petro Road
West Memphis, AR 72301
Phone (615) 661-8929

National Provider Directory

National Provider Directory
Tax ID family
Professional Drivers Medical Depot7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3902 Petro Dr
West Memphis, AR 72301

3902 Petro Dr
#I40
West Memphis, AR 72301
Phone (615) 661-8929

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205038585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 PETRO ROAD",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "72301",
            "telephone_number": "615-661-8929",
            "fax_number": "615-661-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 PETRO ROAD",
            "address_2": "I-40, EXIT 280",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "72301",
            "telephone_number": "615-661-8929",
            "fax_number": "615-661-8977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DRIVERS MEDICAL DEPOTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "615-661-8929",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Memphis, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.