Statewide Medical Supply, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

10724 Issued in AR

Legal business name

STATEWIDE MEDICAL SUPPLY, INC

Practice address

6100 Getty Dr
Ste U
North Little Rock, AR 72117-1635

Phone

(501) 834-1887

Fax

(501) 834-1866

NPI assigned

Nov 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Larry Mark Hickman

Title

Owner

Phone

(501) 834-1887

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1225210735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7246",
            "city": "SHERWOOD",
            "state": "AR",
            "postal_code": "72124",
            "telephone_number": "501-834-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 GETTY DR",
            "address_2": "STE U",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721171635",
            "telephone_number": "501-834-1887",
            "fax_number": "501-834-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE MEDICAL SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-834-1887",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AR",
            "license": "10724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167086716",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Staples, RBT
• Casanda Rochelle Star
• Jarrett W Stark, PA
• Addison Starkey
• State of Arkansas
• Cassandra L. Steele, MS, CCC-SLP
• Stephanie Burnett Aprn, PLLC
• Stephen R Marks MD PA
• Sindra Katherine Stephens, CTRS
• Marla Stephenson, B.A.

• Durable Medical Equipment & Medical Supplies in North Little Rock, AR
• Providers in North 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 Jun 9, 2008; 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.