Provider Demographics
NPI:1447498258
Name:ANAYA MEDICAL, INC
Entity type:Organization
Organization Name:ANAYA MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC,LGAT,CFTS
Authorized Official - Phone:870-864-8882
Mailing Address - Street 1:PO BOX 10505
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-864-8882
Mailing Address - Fax:870-864-8865
Practice Address - Street 1:2700 VINE ST, SUITE C
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-864-8882
Practice Address - Fax:870-864-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180253716Medicaid
AR180253716Medicaid