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General NPI Number Information
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NPI Number | 1538180294
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Entity Type | Organization
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Legal Business Name | QAVANGUQ INC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 35911 KENAI SPUR HWY STE 11
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City | SOLDOTNA
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State | AK
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Zip | 99669-7155
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Country | US
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Telephone | 907-260-4433
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Fax | 907-260-3757
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Provider Business Mailing Address
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Address Line | 35911 KENAI SPUR HWY STE 11
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City | SOLDOTNA
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State | AK
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Zip | 99669-7155
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Country | US
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Telephone | 907-260-4433
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Fax | 907-260-3757
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Authorized Official
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Title or Position | SECRETARY
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Name | MICHELLE PATRICIA MORRELL
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Credential |
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Telephone | 907-260-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 279984
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License Number State | AK
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