Provider Demographics
NPI:1073948808
Name:MEDXM
Entity Type:Organization
Organization Name:MEDXM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:MINARIK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:440-724-6363
Mailing Address - Street 1:21576 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2324
Mailing Address - Country:US
Mailing Address - Phone:440-724-6363
Mailing Address - Fax:
Practice Address - Street 1:21576 N PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2324
Practice Address - Country:US
Practice Address - Phone:440-724-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006700385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care