Provider Demographics
NPI:1144580382
Name:MED X CHANGE, LLC
Entity Type:Organization
Organization Name:MED X CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:636-949-5660
Mailing Address - Street 1:325 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2630
Mailing Address - Country:US
Mailing Address - Phone:636-949-5660
Mailing Address - Fax:636-949-5665
Practice Address - Street 1:325 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2630
Practice Address - Country:US
Practice Address - Phone:636-949-5660
Practice Address - Fax:636-949-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies