NPIMap

Organization Active NPI

Pediatric Nutrition Provider of Arkansas

Doing business as Arkansas Respiratory & Equipment Provider

  • Durable Medical Equipment & Medical Supplies
  • Benton, AR
National Provider Identifier
1265569453
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
MG00511 Issued in AR
Legal business name
PEDIATRIC NUTRITION PROVIDER OF ARKANSAS
Doing business as
Arkansas Respiratory & Equipment Provider
Practice address
920 Edison Ave
Suite 8
Benton, AR 72015-4502
Phone
(501) 315-7337
NPI assigned
Feb 27, 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. Nicole C Motto
Title
Co-Owner
Phone
(501) 315-7337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MG00511 AR Primary

Addresses

Primary practice location

920 Edison Ave
Suite 8
Benton, AR 72015-4502

Mailing address

920 Edison Ave
Suite 8
Benton, AR 72015-4502
Phone (501) 315-7337

Other identifiers 1

IdentifierTypeStateIssuer
49908OtherARBCBS

Other names 1

  • Arkansas Respiratory & Equipment Provider Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Access Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

920 Edison Ave
Ste 8
Benton, AR 72015
Phone (501) 315-7337

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265569453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 EDISON AVE",
            "address_2": "SUITE 8",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154502",
            "telephone_number": "501-315-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 EDISON AVE",
            "address_2": "SUITE 8",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154502",
            "telephone_number": "501-315-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC NUTRITION PROVIDER OF ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOTTO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "501-315-7337",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AR",
            "license": "MG00511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49908",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas Respiratory & Equipment Provider",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, 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.