Healthcare Provider Details

I. General information

NPI: 1306100540
Provider Name (Legal Business Name): MEQUIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 GRAVEL DR
FORT WORTH TX
76118-6965
US

IV. Provider business mailing address

2669 GRAVEL DR
FORT WORTH TX
76118-6965
US

V. Phone/Fax

Practice location:
  • Phone: 682-626-5534
  • Fax:
Mailing address:
  • Phone: 682-626-5534
  • Fax:

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: BRIAN K MENENDEZ
Title or Position: MEMBER
Credential:
Phone: 817-703-5251