NPIMap

Organization Active NPI

Mallard Medical Supply LLC

  • Customized Equipment (DME)
  • Warren, AR
National Provider Identifier
1770914996
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
14306 Issued in AR
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
Dec 13, 2013
Last updated
Dec 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Authorized official

Name
Jeffrey Reed Wardlaw, ATP
Title
Manager
Phone
(870) 226-9501

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X 14306 AR Primary
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 14306 AR
Oxygen Equipment & Supplies (DME) 332BX2000X NU

Addresses

Primary practice location

801 E Church St
Warren, AR 71671-3454

Mailing address

801 E Church St
Warren, AR 71671-3454
Phone (870) 226-9501

National Provider Directory

National Provider Directory
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.

Locations

801 E Church St
Warren, AR 71671
Phone (870) 226-9501

NPI Registry JSON

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1770914996",
    "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": "2013-12-13",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "WARDLAW",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "REED",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "870-226-9501",
        "authorized_official_credential": "ATP"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "AR",
            "license": "14306",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "AR",
            "license": "14306",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; 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.