Provider Demographics
NPI:1689717142
Name:MEDEQUIP HOME MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:MEDEQUIP HOME MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HONEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-464-0400
Mailing Address - Street 1:1401 SE WALTON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3772
Mailing Address - Country:US
Mailing Address - Phone:479-464-0400
Mailing Address - Fax:479-464-8784
Practice Address - Street 1:1401 SE WALTON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3772
Practice Address - Country:US
Practice Address - Phone:479-464-0400
Practice Address - Fax:479-464-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5565080001Medicare ID - Type Unspecified