Wild Medical

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

MG00958 Issued in AR

Legal business name

WILD MEDICAL

Practice address

2821 Kavanaugh Blvd Ste 1C
Little Rock, AR 72205-3868

Phone

(501) 235-8978

Fax

(501) 325-3059

NPI assigned

Jun 2, 2009

Organization subpart

No

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

Authorized official

Name

Stephen Wild

Title

C.E.O.

Phone

(501) 613-4724

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1205062437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 KAVANAUGH BLVD STE 1C",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053868",
            "telephone_number": "501-235-8978",
            "fax_number": "501-325-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 KAVANAUGH BLVD STE 1C",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053868",
            "telephone_number": "501-235-8978",
            "fax_number": "501-325-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "WILD",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "501-613-4724"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AR",
            "license": "MG00958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Wilcox
• Blair Abigail Wilcox
• Joy Deane Wilcox, APN
• Leslie Ann Wilcox, RNP
• Rebecca A Wilcox, SLP
• Diane Davenport Wilder, M.D.
• Georgia Wilder, APRN, NP-C
• Leslie Gayle Wildhagen, APRN-BC
• Mary Anne Wildman, MSPT
• Amber Wiles, CRNA

• Durable Medical Equipment & Medical Supplies in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Durable Medical Equipment & Medical Supplies in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.