Provider Demographics
NPI:1235171042
Name:MEDEQUIP HEALTH CORPOPRATION
Entity Type:Organization
Organization Name:MEDEQUIP HEALTH CORPOPRATION
Other - Org Name:MEDEQUIP HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-798-3500
Mailing Address - Street 1:2602 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2406
Mailing Address - Country:US
Mailing Address - Phone:706-798-3500
Mailing Address - Fax:706-798-5449
Practice Address - Street 1:2602 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2406
Practice Address - Country:US
Practice Address - Phone:706-798-3500
Practice Address - Fax:706-798-5449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDEQUIP HEALTH CORPOPRATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023835332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000862155AMedicaid
GA000862155AMedicaid