Provider Demographics
NPI:1285057307
Name:MEDIEQUIP, INC.
Entity type:Organization
Organization Name:MEDIEQUIP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:INGERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MSOTR
Authorized Official - Phone:314-965-9300
Mailing Address - Street 1:12852 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1803
Mailing Address - Country:US
Mailing Address - Phone:314-965-9300
Mailing Address - Fax:314-965-5487
Practice Address - Street 1:12852 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1803
Practice Address - Country:US
Practice Address - Phone:314-965-9300
Practice Address - Fax:314-965-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO16575571320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO629730508Medicaid
1207890001Medicare NSC