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General NPI Number Information
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NPI Number | 1154693778
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Entity Type | Organization
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Legal Business Name | MEDIQUIP REHABILITATIVE EQUIPMENT & SUPPLIES PLUS LLC
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 808 PIO NONO AVE
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City | MACON
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State | GA
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Zip | 31204-3536
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Country | US
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Telephone | 478-742-1300
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Fax | 478-742-1302
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Provider Business Mailing Address
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Address Line | 808 PIO NONO AVE
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City | MACON
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State | GA
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Zip | 31204-3536
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Country | US
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Telephone | 478-742-1300
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Fax | 478-742-1302
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | MS. AMY L DANIELLY
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Credential |
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Telephone | 478-742-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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