Provider Demographics
NPI:1629384664
Name:MEDIQUEST INC
Entity Type:Organization
Organization Name:MEDIQUEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL IT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAILAN
Authorized Official - Middle Name:OLIQUINO
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-750-7463
Mailing Address - Street 1:1204 SE 28TH ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3881
Mailing Address - Country:US
Mailing Address - Phone:479-464-8833
Mailing Address - Fax:479-750-7462
Practice Address - Street 1:1204 SE 28TH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3881
Practice Address - Country:US
Practice Address - Phone:479-464-8833
Practice Address - Fax:479-750-7462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIQUEST INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145876716Medicaid
AR4136500001OtherMEDICARE PTAN