=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447495783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDIQUIPONE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2008
-----------------------------------------------------
Last Update Date | 12/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 NW CAPITAL DR
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64086-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-308-7292
-----------------------------------------------------
Fax | 816-524-4313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 NW CAPITAL DR
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64086-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-308-7292
-----------------------------------------------------
Fax | 816-524-4313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEPHANIE N SHANHOLTZER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-308-7292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------