Provider Demographics
NPI:1487613329
Name:ARKANSAS OSTOMY, INC
Entity type:Organization
Organization Name:ARKANSAS OSTOMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-868-7840
Mailing Address - Street 1:16607 CANTRELL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4247
Mailing Address - Country:US
Mailing Address - Phone:501-225-8860
Mailing Address - Fax:501-225-8840
Practice Address - Street 1:16607 CANTRELL RD STE 7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4247
Practice Address - Country:US
Practice Address - Phone:501-225-8860
Practice Address - Fax:501-225-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7203332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111614716Medicaid
AR48877OtherBCBS
AR=========30OtherQUALCHOICE
AR0224620001Medicare NSC