Provider Demographics
NPI:1144414970
Name:AMEDIQUEST HEALTH SERVICES
Entity Type:Organization
Organization Name:AMEDIQUEST HEALTH SERVICES
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOUAYARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-340-1024
Mailing Address - Street 1:8112 PURITAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1139
Mailing Address - Country:US
Mailing Address - Phone:313-340-1031
Mailing Address - Fax:
Practice Address - Street 1:8112 PURITAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1139
Practice Address - Country:US
Practice Address - Phone:313-340-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001767261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service