Provider Demographics
NPI:1417957705
Name:QZO, INC.
Entity type:Organization
Organization Name:QZO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-733-5001
Mailing Address - Street 1:1809 GORDON HWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5636
Mailing Address - Country:US
Mailing Address - Phone:706-733-5001
Mailing Address - Fax:706-733-0900
Practice Address - Street 1:1552 RICHLAND AVE W
Practice Address - Street 2:SUITE 310
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3255
Practice Address - Country:US
Practice Address - Phone:803-502-0075
Practice Address - Fax:803-502-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0188Medicaid