Basic Information
| Provider Information | |||||||||
| NPI: | 1689717142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDEQUIP HOME MEDICAL SUPPLIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 SE WALTON BLVD STE 107 | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727123772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794640400 | ||||||||
| FaxNumber: | 4794648784 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 SE WALTON BLVD STE 107 | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727123772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794640400 | ||||||||
| FaxNumber: | 4794648784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HONEA | ||||||||
| AuthorizedOfficialFirstName: | RUSTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4794640400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.