Provider Demographics
NPI:1013719350
Name:WHITTENBURG MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:WHITTENBURG MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-951-6816
Mailing Address - Street 1:19 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7057
Mailing Address - Country:US
Mailing Address - Phone:501-292-6539
Mailing Address - Fax:
Practice Address - Street 1:19 TRADEWINDS DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7057
Practice Address - Country:US
Practice Address - Phone:501-292-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies