Provider Demographics
NPI:1356657365
Name:MEDIQUEST INC.
Entity Type:Organization
Organization Name:MEDIQUEST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAILAN
Authorized Official - Middle Name:OLIQUINO
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-750-7463
Mailing Address - Street 1:121 E VAN BUREN
Mailing Address - Street 2:SUITE E
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-3653
Mailing Address - Country:US
Mailing Address - Phone:479-253-8383
Mailing Address - Fax:479-750-7462
Practice Address - Street 1:121 E VAN BUREN
Practice Address - Street 2:SUITE E
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72632-3653
Practice Address - Country:US
Practice Address - Phone:479-253-8383
Practice Address - Fax:479-750-7462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIQUEST INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4136500001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145876416Medicaid
AR4156500001OtherMEDICARE PTAN