Provider Demographics
NPI:1942394119
Name:MEDEQUIP, INC
Entity Type:Organization
Organization Name:MEDEQUIP, INC
Other - Org Name:MEDICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-443-4414
Mailing Address - Street 1:27 BROOKLINE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1461
Mailing Address - Country:US
Mailing Address - Phone:949-443-4414
Mailing Address - Fax:949-493-4754
Practice Address - Street 1:27 BROOKLINE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1461
Practice Address - Country:US
Practice Address - Phone:949-443-4414
Practice Address - Fax:949-493-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55640332B00000X, 332BC3200X
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942394119Medicaid
CA0718490001Medicare NSC