Provider Demographics
NPI:1356836506
Name:MEDEX MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:MEDEX MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZULFIQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-316-6241
Mailing Address - Street 1:2390 WOODLAKE DR STE 380
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6018
Mailing Address - Country:US
Mailing Address - Phone:517-316-6241
Mailing Address - Fax:
Practice Address - Street 1:2390 WOODLAKE DR STE 380
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6018
Practice Address - Country:US
Practice Address - Phone:517-316-6241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies