Medsource DME, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

000614 Issued in AR

Legal business name

MEDSOURCE DME, INC

Practice address

615 W Moultrie Dr
Blytheville, AR 72315-1936

Phone

(870) 780-6111

Fax

(870) 762-0900

NPI assigned

Jul 18, 2006

Last updated

Aug 22, 2020By 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. James Ernest Stevenson IV

Title

Owner/President

Phone

(870) 780-6111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881612794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W MOULTRIE DR",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151936",
            "telephone_number": "870-780-6111",
            "fax_number": "870-762-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W MOULTRIE DR",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151936",
            "telephone_number": "870-780-6111",
            "fax_number": "870-762-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE DME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ERNEST",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "870-780-6111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AR",
            "license": "000614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BOARD OF PHARMACY",
            "identifier": "000614",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Ashley McCullar, MCD, CCC-SLP
• Danielle Nicole McDuffey
• Jessica McKinnie
• Markeeta Lashawn McRay
• Maria Denise Meadows
• Lartyania Merriweather, LMSW
• Orson Meyer
• Michael C Oldham D C P a
• Mid South Retina Associates, LLC
• Charlotte Middlebrook, BA MHPP

• Durable Medical Equipment & Medical Supplies in Blytheville, AR
• Providers in Blytheville, 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 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.