Healthcare Provider Details

I. General information

NPI: 1568442440
Provider Name (Legal Business Name): MEDEQUIP ONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 N 6TH ST
BISMARCK ND
58501-3913
US

IV. Provider business mailing address

626 N 6TH ST
BISMARCK ND
58501-3913
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-8470
  • Fax: 701-323-8486
Mailing address:
  • Phone: 701-323-8470
  • Fax: 701-323-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number606
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateND

VIII. Authorized Official

Name: STEVEN JACOBCHICK
Title or Position: DIRECTOR
Credential:
Phone: 701-323-8470