Provider Demographics
NPI:1407887607
Name:AZ MEDIQUIP, INC.
Entity Type:Organization
Organization Name:AZ MEDIQUIP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-992-6146
Mailing Address - Street 1:9449 N 90TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5063
Mailing Address - Country:US
Mailing Address - Phone:602-992-6146
Mailing Address - Fax:602-788-4217
Practice Address - Street 1:9449 N 90TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5063
Practice Address - Country:US
Practice Address - Phone:602-992-6146
Practice Address - Fax:602-788-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0573960001Medicare PIN