Provider Demographics
NPI:1023201464
Name:MEDEX HEALTH CARE LLC
Entity Type:Organization
Organization Name:MEDEX HEALTH CARE LLC
Other - Org Name:DBA :ALL AGES FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANNOUFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:480-558-7078
Mailing Address - Street 1:201 W GUADALUPE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3332
Mailing Address - Country:US
Mailing Address - Phone:480-558-7078
Mailing Address - Fax:480-558-7081
Practice Address - Street 1:201 W GUADALUPE RD STE 200
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3332
Practice Address - Country:US
Practice Address - Phone:480-558-7078
Practice Address - Fax:480-558-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33024261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104797Medicare PIN
AZ102454Medicare UPIN