MEDSOURCE DME INC NPI 1881612794

NPI Information

NPI: 1881612794
Provider Name: MEDSOURCE DME, INC
Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
Entity Type: Organization
Address: 615 W MOULTRIE DR
BLYTHEVILLE, AR
ZIP 72315
Phone: (870) 780-6111

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NPI Details

MEDSOURCE DME, INC is a durable medical equipment medical supplies in Blytheville, AR. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. MEDSOURCE DME, INC NPI is 1881612794. The provider is registered as an organization entity type.

The provider's business location address is:

615 W MOULTRIE DR
BLYTHEVILLE, AR
ZIP 72315-936
Phone: (870) 780-6111
Fax: (870) 762-0900

The provider's authorized official is James Ernest Stevenson .
The authorized official title is Owner/president and has the following contact phone number (870) 780-6111.

The enumeration date for this NPI number is 7/18/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies		000614	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000614	OTHER	ARKANSAS	AR BOARD OF PHARMACY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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