Provider Demographics
NPI:1639435464
Name:FAITH MEDICAL INCORPORATED
Entity type:Organization
Organization Name:FAITH MEDICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-276-6162
Mailing Address - Street 1:420 BRODIE LN
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-9606
Mailing Address - Country:US
Mailing Address - Phone:903-276-6162
Mailing Address - Fax:
Practice Address - Street 1:1360 S CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-8652
Practice Address - Country:US
Practice Address - Phone:870-898-3838
Practice Address - Fax:870-898-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies