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General NPI Number Information
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NPI Number | 1619960663
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Entity Type | Organization
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Legal Business Name | JQ MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 6910 S HIGHLAND DR STE 4
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-3087
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Country | US
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Telephone | 800-231-6820
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Fax | 801-880-3634
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Provider Business Mailing Address
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Address Line | 1225 E FORT UNION BLVD STE 310
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City | MIDVALE
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State | UT
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Zip | 84047-1883
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Country | US
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Telephone | 801-942-8582
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Fax | 801-880-3634
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Authorized Official
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Title or Position | VICE PRESIDENT OF REVENUE CYCLE
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Name | TRICIA THURMAN
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Credential |
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Telephone | 801-942-8582
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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 | E42635
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License Number State | UT
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