Provider Demographics
NPI:1245388669
Name:LIFE QUEST MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:LIFE QUEST MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SMOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-731-1250
Mailing Address - Street 1:24820 LAKELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-731-1250
Mailing Address - Fax:216-731-1298
Practice Address - Street 1:24820 LAKELAND BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-731-1250
Practice Address - Fax:216-731-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMEL11046332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH09890003Medicaid
OH09890003Medicaid