Healthcare Provider Details

I. General information

NPI: 1417923343
Provider Name (Legal Business Name): MEDIEQUIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12852 MANCHESTER RD
SAINT LOUIS MO
63131-1803
US

IV. Provider business mailing address

12852 MANCHESTER RD
SAINT LOUIS MO
63131-1803
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-9300
  • Fax: 314-446-1230
Mailing address:
  • Phone: 314-965-9300
  • Fax: 314-446-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DONALD D INGERSON
Title or Position: PRESIDENT
Credential:
Phone: 314-965-9300