Provider Demographics
NPI:1417242611
Name:MEDIQUIP, INC
Entity Type:Organization
Organization Name:MEDIQUIP, INC
Other - Org Name:MEDIQUIP HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RRT/NPS, AE-C
Authorized Official - Phone:516-341-0433
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:STE D
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3715
Mailing Address - Country:US
Mailing Address - Phone:516-341-0433
Mailing Address - Fax:516-612-4975
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:STE D
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3715
Practice Address - Country:US
Practice Address - Phone:516-341-0433
Practice Address - Fax:516-612-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
5308630001OtherMEDICARE PTAN