Provider Demographics
NPI:1881687580
Name:MEDEQ MEDICAL & SURGICAL SUPPLY INC
Entity Type:Organization
Organization Name:MEDEQ MEDICAL & SURGICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ONYEUKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-934-1695
Mailing Address - Street 1:9140 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3317
Mailing Address - Country:US
Mailing Address - Phone:402-934-1695
Mailing Address - Fax:402-934-1635
Practice Address - Street 1:9140 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3322
Practice Address - Country:US
Practice Address - Phone:402-934-1695
Practice Address - Fax:402-934-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE01-9152121332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0590661Medicaid
NE100250417-00Medicaid
IA0590661Medicaid