Healthcare Provider Details

I. General information

NPI: 1619960663
Provider Name (Legal Business Name): JQ MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 S HIGHLAND DR STE 4
SALT LAKE CITY UT
84121-3087
US

IV. Provider business mailing address

1225 E FORT UNION BLVD STE 310
MIDVALE UT
84047-1883
US

V. Phone/Fax

Practice location:
  • Phone: 800-231-6820
  • Fax: 801-880-3634
Mailing address:
  • Phone: 801-942-8582
  • Fax: 801-880-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE42635
License Number StateUT

VIII. Authorized Official

Name: TRICIA THURMAN
Title or Position: VICE PRESIDENT OF REVENUE CYCLE
Credential:
Phone: 801-942-8582