Healthcare Provider Details

I. General information

NPI: 1679550214
Provider Name (Legal Business Name): MEDIQUICK,L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2005
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2362 BLANDING BLVD
MIDDLEBURG FL
32068-4927
US

IV. Provider business mailing address

2362 BLANDING BLVD
MIDDLEBURG FL
32068-4927
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-1463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1312800
License Number StateFL

VIII. Authorized Official

Name: MR. GERALD SOHN
Title or Position: PRESIDENT
Credential:
Phone: 904-591-6377