Provider Demographics
NPI:1376254573
Name:MEDIQ HEALTH LLC
Entity Type:Organization
Organization Name:MEDIQ HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:VESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-862-8668
Mailing Address - Street 1:11051 RANCHO PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4859
Mailing Address - Country:US
Mailing Address - Phone:813-862-8668
Mailing Address - Fax:817-887-3487
Practice Address - Street 1:2445 MERCHANT AVE STE C
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3466
Practice Address - Country:US
Practice Address - Phone:181-386-2866
Practice Address - Fax:817-887-3487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty