1881687580 NPI number — MEDEQ MEDICAL & SURGICAL SUPPLY INC

Table of content: (NPI 1881687580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881687580 NPI number — MEDEQ MEDICAL & SURGICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDEQ MEDICAL & SURGICAL SUPPLY 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:
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:
1881687580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9140 W DODGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-3317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-934-1695
Provider Business Mailing Address Fax Number:
402-934-1635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9140 W DODGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-934-1695
Provider Business Practice Location Address Fax Number:
402-934-1635
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ONYEUKU
Authorized Official First Name:
SAUL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
402-934-1695

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  01-9152121 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0590661 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100250417-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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