=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003819723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMEDEQ INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 DOWNTOWN STE 3
-----------------------------------------------------
City | SPRING BRANCH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78070-4939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-885-2195
-----------------------------------------------------
Fax | 830-228-4582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 249
-----------------------------------------------------
City | SPRING BRANCH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78070-0249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-885-2195
-----------------------------------------------------
Fax | 830-228-4582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHN SIMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-885-2195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------