Mallard Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MALLARD MEDICAL SUPPLY LLC

Practice address

801 E Church St
Warren, AR 71671-3454

Phone

(870) 226-9501

Fax

(870) 226-9500

NPI assigned

Sep 26, 2013

Organization subpart

No

Name

Mr. Jeffrey K Wardlaw

Title

Member

Phone

(870) 460-2814

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

• Mallard Medical Supply LLC

  • Customized Equipment (DME)
  • Warren, AR
  • NPI 1770914996
  NPD tax ID

Medicare fee-for-service enrollment

Enrolled in AR

Tax ID family

Mallard Medical Supply LLC (2 organizations share this tax ID)

• Mallard Medical Supply Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 17, 2014.

{
    "created_epoch": "1380153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1275960965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E CHURCH ST",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716713454",
            "telephone_number": "870-226-9501",
            "fax_number": "870-226-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E CHURCH ST",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716713454",
            "telephone_number": "870-226-9501",
            "fax_number": "870-226-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-26",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "WARDLAW",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "870-460-2814",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "AR",
            "license": "14306",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mallard Medical Supply",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mallard Medical Supply LLC
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• Marsh-George Clinic
• Frederika Vonshae Marshall

• All providers in Warren, AR
• Durable Medical Equipment & Medical Supplies in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.