1700187804 NPI number — MEDX INTERNATIONAL INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700187804 NPI number — MEDX INTERNATIONAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDX INTERNATIONAL 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:
1700187804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 ROCKLAND ST. - SUITE 3
Provider Second Line Business Mailing Address:
MEDX INTERNATIONAL INC.
Provider Business Mailing Address City Name:
NEW BEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02740-3136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-419-6339
Provider Business Mailing Address Fax Number:
508-999-4085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 ROCKLAND ST. - SUITE 3
Provider Second Line Business Practice Location Address:
MEDX INTERNATIONAL INC.
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02740-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-419-6339
Provider Business Practice Location Address Fax Number:
508-999-4085
Provider Enumeration Date:
11/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PSICHOPAIDAS
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
CHIEF OPERATING OFFICER/PARTNER
Authorized Official Telephone Number:
508-999-4021

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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