Provider Demographics
NPI:1154693778
Name:MEDIQUIP REHABILITATIVE EQUIPMENT & SUPPLIES PLUS LLC
Entity type:Organization
Organization Name:MEDIQUIP REHABILITATIVE EQUIPMENT & SUPPLIES PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-742-1300
Mailing Address - Street 1:808 PIO NONO AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3536
Mailing Address - Country:US
Mailing Address - Phone:478-742-1300
Mailing Address - Fax:478-742-1302
Practice Address - Street 1:808 PIO NONO AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3536
Practice Address - Country:US
Practice Address - Phone:478-742-1300
Practice Address - Fax:478-742-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA335E00000X
332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier