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General NPI Number Information
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NPI Number | 1790996999
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Entity Type | Organization
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Legal Business Name | QUALITY CARE MEDICAL EQUIPMENT AND SUPPLIES
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Dates
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Enumeration Date | 05/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1379 OLD BRIDGE RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2710
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Country | US
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Telephone | 703-492-3696
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Fax | 703-492-9796
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Provider Business Mailing Address
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Address Line | 1379 OLD BRIDGE RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2710
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Country | US
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Telephone | 703-492-3696
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Fax | 703-492-9796
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN MANGOMO
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Credential |
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Telephone | 703-492-9696
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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 |
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License Number State |
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