Healthcare Provider Details

I. General information

NPI: 1336024645
Provider Name (Legal Business Name): SERVIQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE 100
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

30 N GOULD ST STE 100
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 409-419-3014
  • Fax:
Mailing address:
  • Phone: 202-998-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LOUIS ANTHONY MORENO
Title or Position: MANGER
Credential:
Phone: 202-998-4127