Provider Demographics
NPI:1043464811
Name:MEDX ACQUISITION CORPORATION
Entity Type:Organization
Organization Name:MEDX ACQUISITION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:DESTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-971-1900
Mailing Address - Street 1:279 GREAT VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1308
Mailing Address - Country:US
Mailing Address - Phone:610-971-1900
Mailing Address - Fax:610-971-2200
Practice Address - Street 1:279 GREAT VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1308
Practice Address - Country:US
Practice Address - Phone:610-971-1900
Practice Address - Fax:610-971-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment