Provider Demographics
NPI: | 1982998738 |
---|---|
Name: | C.B.F.M.C. INC |
Entity type: | Organization |
Organization Name: | C.B.F.M.C. INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | V.P. / DIRECTOR OF OPERATIONS |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KENNETH |
Authorized Official - Middle Name: | RAY |
Authorized Official - Last Name: | SAMPLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 870-932-0150 |
Mailing Address - Street 1: | 202 E WASHINGTON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | JONESBORO |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72401-3102 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 870-932-0150 |
Mailing Address - Fax: | 870-932-0870 |
Practice Address - Street 1: | 401 HIGHWAY 5 N |
Practice Address - Street 2: | |
Practice Address - City: | MOUNTAIN HOME |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72653-3036 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-932-0150 |
Practice Address - Fax: | 870-932-0870 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-06-08 |
Last Update Date: | 2011-06-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | AR20370 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |