Healthcare Provider Details

I. General information

NPI: 1063738656
Provider Name (Legal Business Name): MEDEQUIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 S HIGHWAY 14 STE 1200L
GREER SC
29650-4902
US

IV. Provider business mailing address

27 BROOKLINE
ALISO VIEJO CA
92656-1461
US

V. Phone/Fax

Practice location:
  • Phone: 864-266-8544
  • Fax:
Mailing address:
  • Phone: 949-443-4414
  • Fax: 949-493-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number10099
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SOREN LIND
Title or Position: PRESIDENT
Credential:
Phone: 949-443-4414