MEDICARE: AMEDEQ INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	513395	OTHER	TX	BCBS
2	5080128	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1003819723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEDEQ INC.

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-0249
Country	:	US
Telephone Number	:	830-885-2195
Fax Number	:	830-228-4582

Provider Business Practice Location Address
First Line	:	101 DOWNTOWN
Second Line	:	STE 3
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-4939
Country	:	US
Telephone Number	:	830-885-2195
Fax Number	:	830-228-4582

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN SIMON
Credential	:
Telephone Number	:	830-885-2195

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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Directions to “AMEDEQ INC. ” Practice Location

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