Provider Demographics
NPI:1538180294
Name:QAVANGUQ INC
Entity type:Organization
Organization Name:QAVANGUQ INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-260-4433
Mailing Address - Street 1:35911 KENAI SPUR HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7155
Mailing Address - Country:US
Mailing Address - Phone:907-260-4433
Mailing Address - Fax:907-260-3757
Practice Address - Street 1:35911 KENAI SPUR HWY STE 11
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7155
Practice Address - Country:US
Practice Address - Phone:907-260-4433
Practice Address - Fax:907-260-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK279984332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS7112Medicaid
4597760001Medicare NSC