Provider Demographics
NPI:1902224843
Name:BROOKS MEDICAL OF MOUNTAIN HOME, INC
Entity Type:Organization
Organization Name:BROOKS MEDICAL OF MOUNTAIN HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-424-9808
Mailing Address - Street 1:860 HIGHWAY 62 E
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3248
Mailing Address - Country:US
Mailing Address - Phone:870-424-9808
Mailing Address - Fax:870-424-9810
Practice Address - Street 1:860 HIGHWAY 62 E
Practice Address - Street 2:SUITE 10
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3248
Practice Address - Country:US
Practice Address - Phone:870-424-9808
Practice Address - Fax:870-424-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166731716Medicaid
AR166731716Medicaid