Provider Demographics
NPI:1659807238
Name:JOSEPH LESCANO - MEDQUEST MEDICAL SUPPLY
Entity Type:Organization
Organization Name:JOSEPH LESCANO - MEDQUEST MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LESCANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-646-6875
Mailing Address - Street 1:P.O. BOX 4445
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799
Mailing Address - Country:US
Mailing Address - Phone:684-633-2838
Mailing Address - Fax:684-633-5838
Practice Address - Street 1:4445 MATU'U ROAD
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-2838
Practice Address - Fax:684-633-5838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDQUEST MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier