Provider Demographics
NPI:1457095143
Name:MEDQUIP LLC
Entity Type:Organization
Organization Name:MEDQUIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:IRINA
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-617-4426
Mailing Address - Street 1:1347 FAIRVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4218
Mailing Address - Country:US
Mailing Address - Phone:770-617-4426
Mailing Address - Fax:
Practice Address - Street 1:1347 FAIRVIEW TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4218
Practice Address - Country:US
Practice Address - Phone:770-617-4426
Practice Address - Fax:470-539-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies