Provider Demographics
NPI:1457005464
Name:MAXX MEDICAL INC
Entity Type:Organization
Organization Name:MAXX MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETREQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-438-9500
Mailing Address - Street 1:10554 SUCCESS LN STE A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3657
Mailing Address - Country:US
Mailing Address - Phone:937-438-9500
Mailing Address - Fax:937-886-5694
Practice Address - Street 1:10554 SUCCESS LN STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-3657
Practice Address - Country:US
Practice Address - Phone:937-438-9500
Practice Address - Fax:937-886-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service