MEDICARE: MQ HEALTHCARE DISTRIBUTOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1700689437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MQ HEALTHCARE DISTRIBUTOR LLC

Provider Business Mailing Address
First Line	:	3131 W BOLT ST STE D62
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-5813
Country	:	US
Telephone Number	:	817-901-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 W BOLT ST STE D62
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-5813
Country	:	US
Telephone Number	:	817-901-1770
Fax Number	:

Authorized Official
Title or Position	:	VP/CIO
Name	:	MR. RICARDO LAPORTE
Credential	:
Telephone Number	:	817-901-1770

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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Directions to “MQ HEALTHCARE DISTRIBUTOR LLC ” Practice Location

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