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

Last updated

Jan 17, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey K Wardlaw

Title

Member

Phone

(870) 460-2814

Specialties & licenses 4

Addresses

Other names 1

• Mallard Medical Supply Other name

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Tax ID family

Mallard Medical Supply LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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

{
    "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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• Durable Medical Equipment & Medical Supplies in Warren, AR
• Providers in Warren, 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 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.