MEDICARE: MEDIQUE MEDICAL EQUIPMENT SUPPLY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1932841657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIQUE MEDICAL EQUIPMENT SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1307 E MILLBROOK RD STE C106
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-5476
Country	:	US
Telephone Number	:	919-900-7755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 E MILLBROOK RD STE C106
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-5476
Country	:	US
Telephone Number	:	919-900-7755
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GODWIN CHINEDU CHIDEBE
Credential	:
Telephone Number	:	919-210-5353

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	08/02/2023

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