Provider Demographics
NPI:1568442440
Name:MEDEQUIP ONE, LLC
Entity Type:Organization
Organization Name:MEDEQUIP ONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-323-8470
Mailing Address - Street 1:626 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3913
Mailing Address - Country:US
Mailing Address - Phone:701-323-8470
Mailing Address - Fax:701-323-8486
Practice Address - Street 1:626 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3913
Practice Address - Country:US
Practice Address - Phone:701-323-8470
Practice Address - Fax:701-323-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND332BC3200X, 332BP3500X, 335E00000X
ND606332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND051624Medicaid
ND1278290002Medicare NSC