Provider Demographics
NPI:1912200601
Name:MEDQITS L.L.C
Entity Type:Organization
Organization Name:MEDQITS L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MATINA
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:PRIDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-438-5231
Mailing Address - Street 1:300 MARTIN LUTHER KING JR DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2145
Mailing Address - Country:US
Mailing Address - Phone:404-438-5231
Mailing Address - Fax:
Practice Address - Street 1:300 MARTIN LUTHER KING JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2145
Practice Address - Country:US
Practice Address - Phone:404-438-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies