Provider Demographics
NPI:1235211269
Name:MEDIQUIP MEDICAL SUPPLIES INC OF TUCKER
Entity Type:Organization
Organization Name:MEDIQUIP MEDICAL SUPPLIES INC OF TUCKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:770-270-5808
Mailing Address - Street 1:4404 HUGH HOWELL RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4916
Mailing Address - Country:US
Mailing Address - Phone:770-270-5808
Mailing Address - Fax:770-270-5608
Practice Address - Street 1:4404 HUGH HOWELL RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4916
Practice Address - Country:US
Practice Address - Phone:770-270-5808
Practice Address - Fax:770-270-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPPLIED FOR332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier