Provider Demographics
NPI:1861782385
Name:1ST MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:1ST MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-860-3500
Mailing Address - Street 1:PO BOX 10215
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72812-0215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8952 MARKET ST
Practice Address - Street 2:SUITE 7A
Practice Address - City:DOVER
Practice Address - State:AR
Practice Address - Zip Code:72837-9110
Practice Address - Country:US
Practice Address - Phone:501-860-3500
Practice Address - Fax:800-661-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies