1417957705 NPI number — QZO, INC.

Table of content: (NPI 1417957705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417957705 NPI number — QZO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QZO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417957705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 GORDON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-733-5001
Provider Business Mailing Address Fax Number:
706-733-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1552 RICHLAND AVE W
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801-3255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-502-0075
Provider Business Practice Location Address Fax Number:
803-502-0091
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STILLE
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
706-733-5001

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  028 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AB0188 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com