Provider Demographics
NPI:1497088280
Name:QUALIMED SUPPLY LLC
Entity Type:Organization
Organization Name:QUALIMED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KATU
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-428-9146
Mailing Address - Street 1:12195 HIGHWAY 92
Mailing Address - Street 2:STE 114-314
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3602
Mailing Address - Country:US
Mailing Address - Phone:678-428-9146
Mailing Address - Fax:
Practice Address - Street 1:12195 HIGHWAY 92
Practice Address - Street 2:STE 114-314
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3602
Practice Address - Country:US
Practice Address - Phone:678-428-9146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies